I always have this feeling that open angle and angle closure glaucoma are very much different than they are traditionally thought to be. Though it is obvious that the anterior chamber anatomy is different in these disease but the philosophy goes beyond that. While POAG may present with retinal ganglion cell death, there are chances that this cellualr demise may not be because of elevated IOP while as IOP elevation is the ardent etiology for ACG.
Does it mean that these two disease should be thought to belong to different umbrellas. I don't seem to be comfortable seeing both these disorders under the same umbrella term of glaucoma. Any comments out there?
These are two different disorders which need to be managed very difrently .
Primary acute angle closure glaucoma is an ophthalmic emergency with sudden onset of raised intraocular pressure probably above 40 mm Hg up to 70 mmHg or more. The clinical manifeatations are very classical of severe ocular pain, headache, severe reduction in vision , red eye, lacrimation , very shallow anterior chamber , a hazy cornea , a semi dilated non reacting pupil , usually unilateral in patients over the age of 60, more common in female and many patients complain of haloes when looking at a bright light . Emergency traeement include intravenous Diamox 500 mgs stat followed by Pilocarpine 2 % eye drops half an hour later . Once the eye pressure is under control, the patient will need laser or surgical drainage surgery in both eyes. It is potentailly a bilateral disease .
Open angle glauoma is insiduous in nature and the patient has no symptoms at all in the early phase. It is more common an afftect about 2 % of the popuklation ver the age of 40.The anterior chamber may be of normal depth , and the pupil response is normal. It is a bilateral problem , one eye may be more affected than the other in some patients. The intraocular pressure may be normal , and in some patients it may be slightly elevated up to 24 to 30 mm Hg . It may run in families , thus screening is vital for all of us once we are over the age of 40. Normal tension glaucoma and ocular hypertension need to be ruled out by applanation tonometyery and visual field tes. The patients need to be managed by a the glaucoma team . Follow up is essentail in the Glaucoma clinic
Thanks Dr. Ramesh. Your answer is really wonderful. I would love to know more. If you wish to educate me more, please do.
Thank you
Both types of glaucoma ACG and POAG are ending by optic neuropathy -ganglion cells death and irreversible vision loss if left untreated
Glaucoma is an eye condition that describes a process of optic nerve damage caused by high pressure in the eye. There are three things that generally happen. The pressure in the eye becomes high, the optic nerve becomes damaged and the peripheral vision becomes compromised. There are two general types of glaucoma, open angle and closed angle.
Open Angle Glaucoma
In open angle glaucoma, the drainage canal of the eye called the trabecular mesh work is not anatomically blocked.
Narrow Angle Glaucoma
With narrow angle glaucoma, the drainage canal (angle) of the eye is actually very narrow and therefore reduces fluid outflow.
The pathophysiology of primary closed angle glaucoma and chronic open angle glaucoma is very different , and one must also note that in the latter , the intra-ocular pressure can be within normal range , but is sufficiently high to cause optic neuropathy and visual field loss. There have been lot of work done in identifying genes responsible for chronic open angle glaucoma. Lot of work has been done regarding changes in the canal of schlemn as well as the trabeclar meshwork in chronic open angle glaucoma. Loss of optic nerve fibres is indeed worrying . Is glaucoma a neurological disorder ? It would be useful to have more feedback on this from other readers.
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