Angle Closure Glaucoma: Treatment

In angle-closure glaucoma, the iris bulges forward and blocks the iridocorneal angle, obstructing the Schlemm's canal and halting aqueous humor outflow. This sudden blockage causes intraocular pressure to spike rapidly, triggering acute symptoms including severe headache, eye congestion, nausea, and vomiting. Immediate medical attention is necessary to prevent permanent vision loss.

Pilocarpine is a cholinomimetic drug used for emergency short-term treatment to lower acute intraocular pressure before surgery. It effectively increases aqueous humor drainage by opening the trabecular meshwork, providing rapid pressure relief. However, prolonged use causes side effects such as blurred vision and night blindness, limiting its long-term applicability.

Laser iridotomy is a long-term surgical procedure that uses a laser beam to create a hole in the iris. This opening restores the conventional drainage pathway for aqueous humor through the trabecular meshwork, bypassing the blocked iridocorneal angle and preventing future pressure buildup.

Trabeculectomy, also called filtration surgery, creates an alternative drainage pathway by surgically removing a section of tissue and bypassing the blocked iridocorneal angle entirely. Unlike laser iridotomy, which opens the iris, trabeculectomy establishes a new route where aqueous humor drains into a filtering bleb, providing a more permanent structural solution.

Short-term medical management using drugs like pilocarpine rapidly lowers dangerous intraocular pressure during acute episodes, preventing immediate vision damage. Long-term surgical interventions such as laser iridotomy or trabeculectomy permanently restore aqueous humor outflow pathways, preventing recurrent pressure spikes and ensuring sustained eye health.

Adrenergic antagonists, particularly beta-receptor blockers, are commonly used in glaucoma treatment to reduce aqueous humor production and lower intraocular pressure. These drugs work through adrenergic antagonists pharmacological actions to decrease fluid secretion in the eye, complementing other treatment approaches for sustained pressure control.

Acute angle-closure glaucoma presents with sudden onset of severe symptoms including intense eye pain, severe headache, nausea, vomiting, and eye congestion. Vision may become blurred, and the eye appears red. These symptoms indicate a medical emergency requiring immediate intervention to prevent permanent blindness.