This protocol addresses the specific presentation of chronic angle-closure glaucoma in which the anterior chamber angle is occluded, intraocular pressure is markedly elevated, and the patient is actively symptomatic — a pattern consistent with an acute angle-closure crisis.

Clinical Scenario

The patient presents with an occluded anterior chamber angle and symptomatic high intraocular pressure. Key features include eye pain, headache, nausea and vomiting, and blurred vision with halos. On examination: markedly elevated intraocular pressure, corneal edema, conjunctival and episcleral vascular congestion, and a mid-dilated pupil.

Treatment Approach

Management involves surgical interventional options that remain effective even when corneal clarity is compromised — the complete structured regimen is in the protocol 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.
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.

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Occluded Anterior Chamber Angle with Corneal Edema and Symptomatic High Intraocular Pressure