Angle-closure glaucoma
ICD-10 H40.2 · ICD-11 9C61.3

Angle-Closure Glaucoma with Corneal Edema When Laser Peripheral Iridotomy Has Not Opened the Angle

This protocol addresses the patient in acute angle-closure crisis whose anterior chamber angle remains occluded and intraocular pressure stays markedly elevated after laser peripheral iridotomy — and in whom corneal edema is present, complicating further intervention.

Clinical Presentation

The anterior chamber angle is occluded with symptomatic, markedly elevated IOP. Corneal edema, conjunctival and episcleral vascular congestion, and a mid-dilated pupil are present on examination. The patient reports eye pain, headache, nausea or vomiting, and blurred vision with halos.

Why This Step Is Reached

Laser peripheral iridotomy (LPI) was performed to relieve pupillary block, but failed to achieve the expected angle widening and iris-profile flattening on gonioscopy. The acute angle-closure crisis has not resolved, and further management is required.

Next-Line Approach

When LPI has not broken the attack, surgical and procedural alternatives are available — including approaches that remain applicable even when corneal edema is present. The full structured protocol specifies which intervention applies and under what conditions.

Instant Access to Structured Evidence-Based Regimens

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.

When LPI is not possible or if the AACC cannot be medically broken, laser peripheral iridoplasty surgery (even with a cloudy cornea), paracentesis, and incisional iridectomy remain effective alternatives.

If an LPI cannot be performed due to iris congestion or corneal edema, the cornea may sometimes be cleared using topical hyperosmotic agents, anterior chamber paracentesis, or laser peripheral iridoplasty surgery.

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