Acute angle-closure glaucoma is a medical emergency that arises when the eye’s fluid drainage system becomes suddenly blocked. This blockage causes a rapid and severe increase in intraocular pressure (IOP). The condition is comparable to a plumbing system with a sudden clog. This pressure spike can damage the optic nerve, which transmits visual information to the brain. Without immediate treatment, this event can lead to permanent vision loss.
Symptoms of an Acute Angle-Closure Attack
Recognizing the signs of an acute angle-closure attack is important for seeking prompt medical care. The symptoms appear suddenly and can be intense. A common indicator is severe pain in one eye, which may be accompanied by an ache that radiates around the eye and head. Vision often becomes blurry, and some individuals report seeing rainbow-colored rings or halos around lights.
These ocular symptoms are frequently joined by systemic ones, such as nausea and vomiting, which can sometimes lead to misdiagnosis. The affected eye may appear red, and the pupil might become fixed in a mid-dilated position. Experiencing a combination of these symptoms warrants immediate medical attention to prevent lasting damage to your vision.
Immediate Medical Interventions
Upon arrival at a medical facility, the primary goal is to quickly lower the high intraocular pressure. This is accomplished using a combination of medications. The initial treatment involves various types of eye drops. For instance, beta-blocker eye drops like timolol are used to decrease the production of aqueous humor, the fluid inside the eye.
Systemic medications are also administered either orally or intravenously for a more rapid effect. Acetazolamide is a common choice, which also works to reduce the eye’s fluid production. To help open the blocked drainage angle, miotic eye drops such as pilocarpine are used. This medication constricts the pupil, which pulls the iris away from the eye’s drainage channels, helping to clear the obstruction.
Definitive Laser and Surgical Procedures
After the initial pressure crisis is controlled with medication, a definitive procedure is required to address the underlying anatomical issue and prevent future attacks. The standard treatment is a Laser Peripheral Iridotomy (LPI). This is a quick outpatient procedure where a focused laser creates a tiny hole in the peripheral iris. This new opening provides an alternate route for the aqueous fluid to travel, bypassing the main drainage angle.
Before the LPI procedure, the pupil is constricted with pilocarpine drops to stretch and thin the iris, making it easier for the laser to create the opening. The eye is numbed with anesthetic drops, and a special lens is placed on the eye to focus the laser. In situations where a laser procedure is not feasible, a surgical iridectomy, which involves manually creating an opening in the iris, may be performed. For some patients with a thick cataract, cataract surgery itself can be the treatment, as removing the lens creates more space and widens the drainage angle.
Recovery and Long-Term Management
Following a laser peripheral iridotomy, the recovery period is short. Patients might experience temporary blurred vision, light sensitivity, or a mild headache, but can resume normal activities soon. Anti-inflammatory eye drops are prescribed for a few days to manage any discomfort. Regular follow-up appointments are necessary to monitor the eye’s pressure and ensure the iridotomy remains effective.
Because the anatomical predisposition for angle closure is present in both eyes, the unaffected eye is considered at high risk for a similar attack. A prophylactic LPI is recommended for the fellow eye to prevent a future emergency. While the procedure prevents subsequent acute attacks, it does not cure glaucoma. Patients may still require ongoing monitoring or long-term use of eye drops to manage their intraocular pressure.