Treatment of Angle-closure Glaucoma with Corneal Edema and Markedly Elevated Intraocular Pressure

This protocol covers the acute angle-closure presentation: an occluded anterior chamber angle with symptomatic, markedly elevated IOP accompanied by corneal edema and conjunctival vascular congestion — a presentation requiring urgent IOP reduction.

Clinical Scenario

The patient presents with an occluded anterior chamber angle and markedly elevated intraocular pressure. Key signs and symptoms include:

Eye pain, headache, nausea/vomiting, and blurred vision with halos
Corneal edema
Conjunctival and episcleral vascular congestion
Mid-dilated pupil

Treatment Approach

Medical therapy is typically initiated first, using agents that lower IOP through aqueous suppression, alongside interventions targeting the mechanism of pupillary block — including systemic options for situations requiring a rapid IOP decrease. Additional approaches address cases where the mechanism differs.

Treatment goals: Lowering of IOP, relief of eye pain, and clearing of corneal edema.

References

DOI: 10.1016/j.ophtha.2025.12.030

Acute angle-closure crisis (AACC): occluded angle with symptomatic high IOP

Symptoms of AACC include eye pain, headache, nausea/vomiting, and blurred vision with halos.

Clinical signs of AACC are markedly elevated IOP, corneal edema, conjunctival and episcleral vascular congestion, and/or a mid-dilated pupil.

In AACC, medical therapy is usually initiated first to lower the IOP to reduce pain and clear corneal edema.

Systemic hyperosmotic agents may be required to achieve a rapid decrease in IOP in the setting of AACC.

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