What is the medical treatment for 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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Answer

Topical and oral medications are used to lower the IOP. Lowering the IOP minimizes damage to the optic nerve and allows the ocular tissue to be compressed.

If the IOP cannot be lowered sufficiently, an anterior chamber paracentesis (needle insertion) can be performed. This technique can be useful because it provides immediate relief to the distressed patient and facilitates tolerance of subsequent treatment. A consent form should be obtained for the risks (eg, inadvertent lens puncture, decompression retinopathy) and benefits prior to the procedure.

Compression gonioscopy is then performed by using a gonioscope to push down on the cornea and then easing up on it. The process is done repeatedly, and the force generated is translated intraocularly to break the contact between the iris and the lens (pupillary block) and apposition of the iris to the trabecular meshwork (angle closure). This temporarily restores the outflow of aqueous humor and normalizes the IOP.

Patients may also be placed in a supine position to allow the lens to move away from the anterior chamber to help restore of the flow of aqueous humor.

When the eye is in AAC, the visualization into the anterior chamber is poor. Medications for eye pressure and inflammation are used to help clear up the cornea, to reduce intraocular inflammation, and to decrease iris edema. It is preferable to perform laser iridotomy when the condition can be optimized. If laser iridotomy cannot be performed and AAC continues, surgical iridectomy is indicated.


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