Angle-closure Glaucoma: A Comprehensive Guide

Primary Symptoms

• Severe eye pain that feels like something is stabbing your eye

• Intense headache, often on the same side as the affected eye

• Nausea and vomiting from the severe pain

• Sudden blurred vision or vision changes

• Seeing halos or rainbows around lights

• Red, watery eyes

• The affected eye may feel unusually firm, but do not press on it.

Some people see colored rings around lights before their vision gets blurry. Your eye may feel tender, but do not press on or touch it to test for tenderness. The white part of your eye might look very red and irritated.

When to Seek Care

Call 911 or go to the emergency room immediately if you have severe eye pain with headache and nausea. Don't wait to see if symptoms get better. Prompt treatment gives you the best chance of preventing permanent vision loss.

Every hour that passes without treatment makes vision loss more likely. Even if you're not sure if it's an emergency, it's better to get checked right away. Doctors would rather see you and find everything is okay than miss a real emergency.

When to Seek Immediate Care

Any combination of severe eye pain, headache, nausea, and vision changes requires immediate emergency medical attention.

Medical History & Physical Examination

Your doctor will ask about your symptoms and how quickly they started. They'll check your eye pressure right away using a special device. The doctor will also examine your eye with a bright light to see the drainage angle. They'll look for signs of eye inflammation and check how your pupils respond to light.

During the exam, your doctor will measure the pressure in your eye and look for signs of angle closure. They'll also check your other eye to see if it might be at risk for the same problem. This helps catch problems before they become emergencies.

Diagnostic Testing

• Tonometry measures the pressure inside your eye using a small device

• Gonioscopy uses a special lens to look at your eye's drainage angle

• Optical coherence tomography (OCT) takes detailed pictures of your eye's internal structures

• Visual field testing checks for areas of vision loss

• Pachymetry measures the thickness of your cornea

Conservative Treatments

• Eye drops to reduce fluid production and improve drainage

• Oral medications like acetazolamide to quickly lower eye pressure

• IV medications if oral drugs don't work fast enough

• Topical steroid drops may be used to reduce inflammation as part of treatment.

Medications work by either making less fluid or helping more fluid drain out. Some people need ongoing eye drops after laser or surgical treatment, while others may not. Your eye doctor will decide based on your eye pressure and any remaining damage or angle closure. Your doctor will find the best combination of medications for your specific case.

Advanced Treatments

• Laser peripheral iridotomy creates a small hole in the iris to improve drainage

• Surgical iridectomy removes a small piece of iris when laser treatment isn't possible

• Trabeculectomy surgery creates a new drainage pathway when other treatments fail

• Glaucoma drainage devices for severe cases that don't respond to other treatments

Laser treatment is quick and can often be done in a doctor's office. Most people feel better within hours after laser treatment. Surgery may be needed if laser treatment doesn't work well enough.

Daily Management Strategies

Take your eye drops exactly as prescribed, even if you feel fine. Keep a schedule to remember your medications. Some medicines, including certain antihistamines and other drugs that dilate the pupil, may trigger an attack in people with untreated narrow angles. Ask your eye doctor or pharmacist before stopping or starting a medicine. Tell all your doctors about your condition before they prescribe new medications. Wear sunglasses for comfort and UV protection, but not as a way to prevent angle closure.

Set phone reminders to help you remember your eye drops at the same time each day. Keep a list of medications to show all your doctors. Check with your eye doctor before taking any new over-the-counter medications or supplements.

Exercise & Movement

Regular exercise is safe and healthy for most people with treated angle-closure glaucoma. Avoid activities that involve hanging upside down or putting your head below your heart for long periods. Swimming and walking are excellent choices. Yoga poses that invert your body should be avoided.

Talk to your doctor about which activities are safe for you. Most everyday activities like gardening and playing with kids are perfectly fine. Just keep your follow-up appointments and watch for any warning signs.