BACKGROUND: Mismanagement of angle closure glaucoma (ACG) can quickly result in blindness. Angle closure glaucoma, both acute and chronic, accounts for almost 10% of glaucoma cases in the U.S. Internationally, ACG accounts for approximately 80% of primary glaucoma in Asia. Pathophysiologically, acute ACG may occur in a primary fashion where no cause other than an anatomic predisposition is identified or in a secondary fashion where a specific pathology in any part of the eye induces the ACG. Chronic ACG is induced by segments of the anterior chamber angle that are permanently closed by peripheral anterior synechia. In some instances, a patient who is considered to have chronic ACG proceeds to acute ACG prior to presentation.
CASE REPORT(S). We report on 5 widely different cases of acute ACG, where upon presentation the patients demonstrated IOP between 40-60mmHg with acute signs and symptoms, and a case of glaucomatocyclitic crisis. The ACG cases include 1) phacomorphic AC, 2) classic primary AC, 3) plateau iris configuration AC, 4) post-phaco/uveitis-induced AC, and 5) essential iris atrophy AC. The cases will include details on presentations, etiologies, treatment, prognosis and follow-up.
CONCLUSIONS. In each patient, an initial attempt to identify the anatomical and pathophysiological alterations was found to be the most significant factor in arriving at the correct diagnosis and selecting the most appropriate treatment. The poster discusses the differential diagnosis of angle closure glaucoma and presents an algorithm that may help streamline the diagnostic pathway. Moreover, a concise review of acute and long-term treatment modalities will be discussed. This review will enable the primary care optometrist to confidently manage the many etiological faces of angle closure glaucoma.