H40.21 Acute angle-closure glaucoma

Name of the Condition

• Acute Angle-Closure Glaucoma

Summary

Acute angle-closure glaucoma is a sudden, severe form of glaucoma characterized by rapid closure of the eye's drainage angle, leading to a rapid increase in intraocular pressure. This condition can cause significant pain, vision loss, and optic nerve damage if not treated promptly. It is a medical emergency requiring immediate intervention to prevent permanent vision impairment.

Causes

The primary cause is a sudden blockage of the eye's drainage angle, often due to anatomical factors such as a thickened or forward-positioned lens. This blockage prevents aqueous humor from draining, causing intraocular pressure to rise rapidly. Contributing factors may include pupil dilation, inflammation, or structural abnormalities in the eye's anterior segment.

Risk Factors

• Anatomically narrow drainage angles.
• Farsightedness (hyperopia).
• Age over 40.
• Family history of glaucoma.
• Asian or Inuit descent.
• Certain medications that dilate the pupil.
• Previous episodes of angle closure.

Symptoms

• Severe eye pain or headache.
• Blurred vision.
• Halos around lights.
• Nausea or vomiting.
• Redness in the eye.
• Sudden loss of vision.

Diagnosis

Diagnosis involves a comprehensive eye examination, including tonometry to measure intraocular pressure, gonioscopy to assess the drainage angle, and optical coherence tomography to evaluate the anterior segment. Additional tests may include visual field testing and optic nerve imaging to assess damage.

Treatment Options

Treatment focuses on rapidly lowering intraocular pressure through medications (e.g., eye drops, oral medications) and procedures (e.g., laser iridotomy, surgical iridectomy). Long-term management may include laser or surgical interventions to prevent recurrence.

Prognosis and Follow-Up

With prompt treatment, vision loss can be minimized, but some permanent damage may occur. Regular follow-up appointments are essential to monitor intraocular pressure and optic nerve health. Patients may require ongoing treatment to prevent future episodes.

Complications

Untreated acute angle-closure glaucoma can lead to permanent vision loss, optic nerve damage, or blindness. Recurrent episodes increase the risk of chronic angle-closure glaucoma.

Lifestyle & Prevention

• Avoid medications that dilate the pupil without consulting a healthcare provider.
• Regular eye examinations, especially for those with risk factors.
• Manage underlying conditions like farsightedness.
• Follow post-treatment care instructions to prevent recurrence.

When to Seek Professional Help

Seek immediate medical attention if experiencing severe eye pain, blurred vision, halos around lights, or sudden vision loss. These symptoms may indicate acute angle-closure glaucoma, a medical emergency.

Tips for Medical Coders

Document the acute nature of the condition, including onset and severity. Note any interventions (e.g., laser, surgery) and follow-up care. Ensure documentation supports the diagnosis and treatment provided, as acute angle-closure glaucoma requires urgent management.