Glaucoma
Primary Angle-Closure Disease
Also known as: primary angle closure, primary angle closure suspect, PACS, PAC, PACG, primary angle-closure glaucoma, chronic angle closure, narrow angles
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A spectrum in which the peripheral iris sits against the trabecular meshwork and obstructs aqueous outflow. It has three chronic stages, and the stage sets the action. A primary angle-closure suspect has an occludable angle and nothing else. Primary angle closure adds a raised pressure and/or peripheral anterior synechiae. Primary angle-closure glaucoma adds glaucomatous optic nerve or visual field damage. Most patients have no symptoms, so the disease is found only by looking at the angle. Gonioscopy with lens tilt and indentation is the examination that stages it. The acute attack is a separate emergency record.
Recognition
Symptoms: what patients report
- Usually none at any of the three stages
- Intermittent haloes, blur, brow ache or a red eye in dim light or in the evening, settling on their own, raise concern for intermittent closure
- Severe pain, nausea, haloes and reduced vision belong to an acute attack and are managed as Acute Angle Closure Glaucoma
Signs: what the examination shows
- Shallow limbal anterior chamber on the van Herick estimate
- On gonioscopy, posterior trabecular meshwork not visible on lens tilt, or iridotrabecular contact, in two or more quadrants (180 degrees or more)
- Steep or convex iris contour: more structures are seen on lens tilt than in primary gaze
- Peripheral anterior synechiae: tapered adhesions that extend beyond the meshwork and do not open on indentation
- Intraocular pressure that is normal in a suspect and above 21 mmHg in primary angle closure
- Glaucomatous disc, retinal nerve fibre layer or visual field change in primary angle-closure glaucoma, with or without a raised pressure
- Hyperopia, a short eye and a thickening lens in an older adult
What OptoGuide™ covers for primary angle-closure disease
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting