Chronic Angle-Closure Glaucoma with Corneal Edema When Medical IOP-Lowering Therapy Has Not Achieved Goals
This protocol covers the management of chronic angle-closure glaucoma presenting with an occluded anterior chamber angle and symptomatic, markedly elevated intraocular pressure — specifically after initial medical therapy for acute angle-closure crisis failed to lower IOP and clear corneal edema.
Clinical Presentation
The anterior chamber angle is occluded, with symptomatic high intraocular pressure. Presenting features include eye pain, headache, nausea and vomiting, and blurred vision with halos. Examination findings are markedly elevated IOP, corneal edema, conjunctival and episcleral vascular congestion, and a mid-dilated pupil.
Previous Treatment — Goals Not Met
An initial course of medical therapy for acute angle-closure crisis — including aqueous-suppressant beta-adrenergic antagonists, carbonic anhydrase inhibitors, parasympathomimetics, and systemic hyperosmotic agents — was undertaken with the aim of lowering IOP to reduce pain and clear corneal edema. This protocol applies when those goals have not been achieved.
Next-Line Approach
Management at this stage centers on a laser-based or surgical procedure directed at relieving the underlying mechanical block. The full protocol — including candidacy criteria, procedure selection, and sequencing — is available via the link below.
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.
- Laser peripheral iridotomy should then be performed as soon as safely feasible.
- Laser peripheral iridotomy is the preferred surgical treatment because it has a favorable risk-benefit ratio.
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