Introduction  

Chronic angle-closure glaucoma is an eye condition that develops when the iris, the colored part of the eye, slowly obstructs the eye’s drainage angle. The blockage causes fluids to build up behind the iris. As a result, the pressure inside the eye gradually increases.

The eye’s anterior chamber angle is made of the iris and the cornea. Where the angle is close, and these two parts are near each other, scar tissue can form between them. Over time, the scar tissue may overlay the eye’s drainage canal. It causes the internal eye pressure to increase slowly and glaucoma to develop. This process is known as chronic angle-closure glaucoma.
In most cases, this disease progresses slowly and tends to be diagnosed in its advanced stages. Chronic angle-closure glaucoma is a significant cause of blindness in Asia.
It is crucial to note that although in most patients the disease progresses gradually, a rapid increase in internal eye pressure may occur within the context of this eye condition. It is a real medical emergency which must be treated immediately or one risks severe permanent eye damage.

Also Known As

Creeping Angle-Closure Glaucoma

Causes and Risk Factors

The cause of this eye disorder is uncertain. Medical evidence suggests that there are many factors involved. These include:

  • Eye surgery complications
  • Blockage of the pupil
  • Iris plateau configuration
  • Defective eye structure
  • Severe diabetic eye disease
  • Eye trauma
  • Tumors 
  • Hyperopia

Some people have a higher risk of developing the condition including those who are:

  • Farsighted
  • Over 50
  • Women 
  • Have cataracts
  • Eskimos and Asians
  • Have relatives who are suffering from the eye disorder
     

Signs & Symptoms

The onset of chronic angle-closure glaucoma can be insidious.  A patient may not notice any symptoms until the later stages or when he/she develops acute angle-closure glaucoma. 

Symptoms include: 

  • Hazy or blurred vision
  • Severe eye pain
  • Cloudy cornea
  • Sudden vision loss
  • A headache
  • Red eye
  • Nausea
  • Vomiting accompanied by eye pain
  • Colored rings, rainbows or halos around lights at night
     

Diagnosis

The eye professional will conduct a complete eye exam to diagnose chronic angle-closure glaucoma. A tonometer is used to measure eye pressure, a gonioscopy to look at the drainage angle, and a professional examines the optic nerve. He/she also tests the peripheral vision.

Treatment 

Treatment is geared at reducing the intraocular pressure.

Medical Treatment

The key to treating chronic angle-closure glaucoma is early diagnosis and active therapy. The eye doctor may prescribe topical eye drops to lower the intraocular pressure. Treatment may also involve systemic medications taken orally or through injections.

Patients may need medication in the long term for the condition.

Surgical Treatment

Sometimes the condition is resistant to therapy. In fact, in most cases, chronic angle-closure glaucoma requires some form of surgery because of the delay in detecting it. It may need laser surgery (laser iridology or laser iridoplasty) or non laser glaucoma surgery.

Surgery attempts to break the attachment of the iris to the cornea and open up the drainage canal. It allows the fluid to drain better and lower the intraocular pressure. Surgery also tries to prevent future blockages.
Where the eye’s drainage system has suffered considerable damage, the doctor may prescribe a regime of medication. It helps reduce the intraocular pressure after the surgery.

Prognosis/Long-term outlook

Chronic angle-closure glaucoma is an insidious disease. It can cause permanent loss of vision if not properly treated by an eye doctor. The condition can advance to an acute stage, or the patient may experience a sudden attack leading to irreversible eye damage.

The condition is manageable with early diagnosis and proper treatment. Patients should get regular eye check-ups and professional guidance.

Prevention/Follow Up

It is essential to lead a healthy lifestyle that includes a nutritious diet and regular exercise. It improves an individual’s mental and physical well being. One should also take care of their spiritual and emotional well being.

Individuals at a higher risk of developing the disorder should get regular eye exams. People should wear protective eye gear when working with chemicals, machinery or using tools. This protects against eye injury that can lead to elevated intraocular pressure.

Patients must avoid situations or anything that can trigger a rapid increase of the internal eye pressure. These include dilating eye drops, stress, excitement, dark places, dim lighting, and some over the counter medications.