What Is Narrow Angle Glaucoma?

narrow angle glaucoma

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Narrow angle glaucoma, sometimes called angle-closure glaucoma or closed-angle glaucoma, is one of several eye disorders known as glaucoma that can harm the optic nerve and impair vision.

In narrow angle glaucoma, the angle between the iris and cornea (the colored area of the eye) is closed or narrow which may interfere with the appropriate drainage of aqueous humor (the fluid within the eye). This may result in elevated intraocular pressure (IOP), which, if left untreated, can harm the optic nerve over time and impair eyesight.

Acute or chronic narrow angle glaucoma is also possible. Acute narrow angle glaucoma develops rapidly and is regarded as a medical emergency since it can result in excruciating eye discomfort, impaired vision, redness, headaches, nausea, and vomiting, among other serious symptoms. Contrarily, chronic narrow angle glaucoma develops gradually and may not show symptoms until later stages, making routine eye exams crucial for early detection.

Narrow-angle glaucoma symptoms

Severe eye pain, headaches or migraines, fuzzy lights or halo figures, pupil dilation, vision problems, bloodshot eyes, and physical illness are some of the early symptoms of narrow angle glaucoma that you should be aware of. These symptoms may disappear after a few hours or continue until the intraocular pressure is at its lowest.

Your peripheral vision can be impacted by each episode of Narrow Angle Glaucoma, which means vision loss could follow. Because Narrow Angle Glaucoma can worsen slowly and in more episodes, it might harm the eyes in ways that were not expected. Angle Closure Glaucoma is exceedingly critical and more of an urgent emergency since it requires rapid relief from the eye’s pressure to prevent vision loss.

Narrow-angle glaucoma causes

The iris, the colored portion of the eye that surrounds the pupil, is typically bent forward, which constricts the area between the clear cornea and the iris, where the drainage angle of the eye is situated, and is the primary cause of narrow-angle glaucoma.

Narrow-angle glaucoma is connected with the following conditions:

The ciliary body, which is the structure behind the iris that creates the aqueous fluid in the eye, is too far forward in the eye when there is an iris plateau. This pushes the peripheral iris forward, making the drainage angle smaller than usual and more susceptible to occlusion by the peripheral iris’s front surface.

Highly farsighted individuals are more likely to have shallow anterior chambers (the area in front of the eye between the cornea and iris) & narrow angles, which raises their chance of developing angle-closure glaucoma.

Tumors or additional causes -Angle-closure glaucoma can also be brought on by a tumor below the iris, swelling brought on by ciliary body inflammation (intermediate uveitis), and changes to the shape of the eye following surgery for a detached retina.

Stages of narrow angle glaucoma

Stages of narrow angle glaucoma

Based on the severity of the condition, narrow angle glaucoma, also known as angle-closure glaucoma, can be divided into many stages. Depending on the individual method or criteria employed by the ophthalmologist or eye care specialist, the categorization and staging of narrow angle glaucoma may differ. Here are some examples of widely utilized narrow angle glaucoma staging systems:

The Shaffer grading system, created by Dr. Robert N. Shaffer, divides narrow angle glaucoma into different categories based on how the cornea’s angle with the iris (the colored area of the eye) looks. Angles can be graded from Grade 0 (wide open) to Grade 4 (full closure).

Classification to the American Academy of Ophthalmology (AAO): Primary Angle Closure Suspect (PACS), Primary Angle Closure (PAC), Acute Angle Closure Crisis (AAC), and Chronic Angle Closure Glaucoma (CACG) are the four stages that the AAO divides narrow angle glaucoma into. The presence of symptoms, the degree of angle closure, and the presence of glaucomatous optic nerve injury are all taken into account in this classification.

Classification by the International Society for Geographical and Epidemiological Ophthalmology (ISGEO). The ISGEO classification is a more thorough method that considers the existence of particular glaucoma risk indicators, such as the appearance of the optic nerve head, visual field abnormalities, and intraocular pressure. Primary Angle Closure Suspects (PACS), Primary Angle Closure (PAC), and Primary Angle Closure Glaucoma (PACG) are some of the subcategories included in it.

Ophthalmologists utilize these staging methods to determine the severity of narrow angle glaucoma and to direct therapy choices. As the management of narrow angle glaucoma can vary based on the stage and severity of the problem, it is crucial to contact your eye care provider to determine the proper staging system and treatment plan for your unique situation.

Narrow-angle glaucoma risk factors

There are some traits that increase a person’s chance of developing narrow-angle glaucoma. These dangers consist of:

Hyperopia

Farsighted people are more likely to have shallow anterior chambers and narrow angles in their eyes, which raises their risk of developing narrow-angle glaucoma.

Age 

As you get older, your anterior chamber tends to get shallower and your drainage angle may get smaller.

Race 

Individuals with narrower anterior chamber drainage angles include Asians, Inuit, and other northern indigenous people. As a result, narrow-angle glaucoma is more common in these people.

Sex 

In Caucasians, women are three times more likely than men to develop narrow-angle glaucoma. Men and women in the African American community seem to be equally impacted.

Treatments for narrow-angle glaucoma

Treatments for narrow-angle glaucoma

The best strategy to manage narrow-angle glaucoma is to maintain safe, steady ocular pressure. Here are a few techniques for doing so:

Eye drops 

Some cases of narrow-angle glaucoma may be successfully treated with topical glaucoma eye drops.

Surgery 

To lower your risk of angle-closure attacks, your eye doctor may recommend glaucoma surgery if evidence of narrow-angle glaucoma is found during an eye exam.

Patients with narrow-angle glaucoma often undergo iridotomy and iridectomy procedures.

In order to improve fluid outflow and lessen the chance of angle closure, surgeons perform an iridotomy by using a laser to make a tiny hole in the peripheral iris. To improve the fluid flow in the eyes, a little portion of the iris is removed during an iridectomy.

Although knowledge of the potential abrupt onset and serious risk of narrow-angle glaucoma can easily generate anxiety, don’t be alarmed. A thorough eye exam can quickly identify the condition, and there are both surgical and nonsurgical treatments available.

The first step in prevention is knowledge. It’s time to schedule an eye checkup if you qualify as “at-risk” and it’s been some time since your last one. You at least experience a sense of calm. You at most keep your vision.

What potential side effects could surgery for narrow angle glaucoma have?

The following are some potential concerns associated with surgery for narrow angle glaucoma:

Bleeding: Bleeding in the eye following surgery can raise intraocular pressure and impair vision.

Any surgical operation, including surgery for narrow angle glaucoma, carries the risk of infection. Loss of vision or even the loss of an eye may result from this.

The chance of acquiring cataracts after surgery for narrow angle glaucoma may increase. Cataracts can impede vision and necessitate additional surgery.

Surgery can occasionally cause damage to the eye’s surrounding tissues, which can result in concerns like double vision or difficulty moving the eye.

Surgery for narrow angle glaucoma sometimes fails to successfully control eye pressure, which might cause further vision loss or necessitate the need for subsequent therapy.

In order to choose the best course of action for your unique situation, it’s crucial to explore the risks and advantages of surgery with your ophthalmologist.

When ought a patient to think about having an iridotomy?

When ought a patient to think about having an iridotomy

The surgical operation known as an iridotomy is frequently used as a therapeutic option for narrow angle glaucoma, also referred to as angle-closure glaucoma. It entails making a tiny hole in the colored area of the eye, the iris, to facilitate fluid drainage from the eye and lower the elevated intraocular pressure brought on by narrow angle glaucoma. A patient with narrow angle glaucoma might think about getting an iridotomy in the following circumstances:

An iridotomy may be suggested as the first course of treatment for patients who have been diagnosed with narrow angle glaucoma in order to avoid or control rising intraocular pressure. It might be taken into account if the patient is at a high risk of experiencing an acute angle closure crisis, a dramatic and abrupt rise in intraocular pressure that can result in loss of vision.

When narrow angle glaucoma symptoms appear

Severe eye pain, blurred vision, haloes surrounding lights, redness, and nausea/vomiting are some symptoms of narrow angle glaucoma. An iridotomy may be advised as an urgent or emergency operation if a patient has narrow angle glaucoma symptoms in order to treat the acute angle closure crisis and the symptoms.

As a preventive measure

Patients who are at high risk of developing narrow angle glaucoma due to anatomical factors such a narrow angle configuration or a history of prior angle-closure events may occasionally be advised to have an iridotomy. To avoid the emergence of acute angle closure crises in the future, this could be done as a preventative strategy.

When other treatments are ineffective

An iridotomy may be considered as a surgical option to help lower intraocular pressure and stop further damage to the optic nerve in a patient with narrow angle glaucoma if other conservative treatments, such as medication or laser therapy, are not successfully managing the condition.

An ophthalmologist or other eye care specialist should be consulted before deciding whether to have an iridotomy. This person will evaluate the condition, risk factors, and general health of the patient to choose the best course of action. For the best management of narrow angle glaucoma, patients must heed the advice of their healthcare professional and stick to the recommended medication schedule.

FAQ’s

What is the severity of narrow angle glaucoma?

One form of glaucoma, known as narrow-angle glaucoma, can cause abrupt and irreversible blindness. Less than 10% of all glaucoma diagnoses are due to narrow-angle glaucoma, yet it can still result in excruciating discomfort, quick vision loss, and even blindness.

What Narrow Angle Glaucoma therapy is most effective?

The goal of treatment is to reduce eye pressure with eye drops and maybe oral drugs, although performing a laser iridotomy at the time of a glaucoma attack is the only effective option. A tiny hole is made in the iris during this treatment to allow the iris to separate from the eye’s drainage region.

How dangerous are narrow angles?

Iris and cornea are too near together in a person with narrow angles. Fluid cannot exit the eye when the drainage angle is so small that the iris touches the cornea. Glaucoma may develop as a result of increased ocular pressure.

When I have narrow-angle glaucoma, what should I avoid?

  • drugs for the cold or decongestants.
  • Anti-allergy drugs
  • medicine for anxiety and depression  (DO NOT stop taking these without first talking to your doctor; doing so could cause withdrawal symptoms.)
  • nausea/reflux medicine.
  • medicine for overactive bladder or incontinence.

How quickly can Narrow Angle Glaucoma result in blindness?

It is an emergency because acute narrow-angle glaucoma often develops quickly. This glaucoma causes blindness in the affected eye in three to five days if it is not treated very away. There may be discomfort and inflammation as symptoms.

About the Author:
Dr Shaun Larsen

Dr Shaun Larsen

Dr. Shaun Larsen is an optometrist who specializes in low vision services and enhancing vision with contact lenses. He has a passion for making people's lives better by helping them see well enough to read, write, or drive again. He always keeps up with the latest technology so he can help people regain their independence.

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