Which physical findings are characteristic of acute angle-closure glaucoma (AACG)?

Updated: Jun 20, 2019
  • Author: Albert P Lin, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Diagnosis of AAC is based on gonioscopic visualization of an occluded anterior chamber angle in the affected eye and predisposing angle configuration (narrow occludable angle) in the contralateral unaffected eye.

Tonometry demonstrates an elevated IOP, which may be as high as 40-80 mm Hg.

Slit-lamp examination may reveal conjunctival injection, a fixed or sluggish and mid-dilated pupil, a shallow anterior chamber, corneal epithelial edema and bullae, and cells and flare. The patient may be sensitive to light, and the eye may be tearing and closed.

Ophthalmoscopy may reveal a swollen optic disc in an acute attack or excavation if episodes have been chronic or repetitive. Unilateral involvement and worsening symptoms are common in AAC.

If previous episodes of angle closure have occurred, the following may be visible:

  • Posterior and peripheral anterior synechiae adhesions between the lens and iris and between the iris and trabecular meshwork
  • Glaucoma flecks (vesicles on the anterior subcapsular lens)
  • Atrophy of the iris (thinning and whitening of the iris)

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