H40.213 Acute angle-closure glaucoma, bilateral

Name of the Condition

• Acute Angle-Closure Glaucoma, Bilateral

Summary

Acute angle-closure glaucoma, bilateral, is a sudden, severe form of glaucoma characterized by rapid closure of both eyes' drainage angles, 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 in both eyes.

Causes

The primary cause is a sudden blockage of both eyes' drainage angles, often due to anatomical factors such as thickened or forward-positioned lenses. 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 eyes' anterior segments.

Risk Factors

• Anatomically narrow drainage angles in both eyes.
• 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 in both eyes.
• Blurred vision in both eyes.
• Halos around lights in both eyes.
• Nausea or vomiting.
• Redness in both eyes.
• Sudden loss of vision in both eyes.

Diagnosis

Diagnosis involves a comprehensive eye examination, including tonometry to measure intraocular pressure, gonioscopy to assess the drainage angles, and evaluation of optic nerve health. Additional tests may include visual field testing and anterior segment imaging to confirm bilateral involvement and rule out other conditions.

Treatment Options

Treatment focuses on rapidly lowering intraocular pressure to preserve vision. Initial interventions may include medications (e.g., eye drops, oral agents) to reduce pressure, followed by laser or surgical procedures (e.g., iridotomy) to create alternative drainage pathways. Bilateral cases require simultaneous or sequential treatment of both eyes to prevent vision loss.

Prognosis and Follow-Up

With prompt treatment, prognosis is generally good, but delayed intervention can lead to permanent vision loss. Follow-up care includes regular monitoring of intraocular pressure, optic nerve health, and visual function. Long-term management may involve ongoing medications or preventive procedures to reduce recurrence risk.

Complications

Untreated or delayed treatment can result in permanent vision loss, optic nerve damage, or blindness. Recurrent episodes may increase the risk of chronic angle closure or secondary glaucoma. Rare complications include corneal damage or cataract formation.

Lifestyle & Prevention

Avoid triggers that dilate pupils (e.g., certain medications, dim lighting). Regular eye exams are recommended for those with risk factors. Protective eyewear may be advised in specific situations. Maintain overall eye health through balanced nutrition and avoiding smoking.

When to Seek Professional Help

Seek immediate medical attention if experiencing sudden eye pain, blurred vision, halos around lights, or nausea/vomiting, as these may indicate acute angle-closure glaucoma. Do not delay care, as rapid intervention is critical to prevent permanent vision loss.

Tips for Medical Coders

Document the bilateral nature of the condition clearly in the medical record. Ensure the diagnosis is supported by clinical findings (e.g., tonometry results, gonioscopy) and specify if treatment was provided. Use this code only when the condition is acute and involves both eyes; unilateral cases require different codes.