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Acute Angle-Closure Glaucoma

Ophthalmologic emergency caused by sudden blockage of aqueous humor outflow with rapid rise in intraocular pressure (>40 mmHg), presenting with severe eye pain, headache, nausea, blurred vision with halos around lights, and corneal edema, requiring urgent IOP-lowering medications and laser peripheral iridotomy to prevent permanent vision loss.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Acute Angle-Closure Glaucoma?

Acute angle-closure glaucoma (AACG) is an ophthalmologic emergency caused by sudden mechanical blockage of aqueous humor outflow at the trabecular meshwork due to forward bowing of the iris (pupillary block mechanism) in eyes with anatomically narrow angles. Pathogenesis involves relative pupillary block where aqueous flow from posterior to anterior chamber is impeded, causing pressure differential, iris bombe, and angle closure with sudden IOP rise to 40-80 mmHg.

Risk factors include female gender (3:1), age >50 years, hyperopia (short axial length), shallow anterior chamber (<2.5 mm), thick lens, family history, Asian or Inuit descent, and precipitating factors such as pupillary dilation (dim lighting, stress, emotional upset), medications (anticholinergics, topiramate, sulfonamides, decongestants), and prone position. Plateau iris configuration is a non-pupillary block mechanism in younger patients.

Diagnosis is clinical: severe unilateral eye pain, blurred vision with halos around lights, nausea/vomiting, conjunctival injection, mid-dilated non-reactive pupil (4-6 mm), corneal edema (steamy/hazy), and IOP >40 mmHg (often 50-80) measured by tonometry. Gonioscopy of fellow eye confirms narrow angles. Anterior segment OCT or UBM can confirm angle closure. Differential diagnosis includes neovascular glaucoma, uveitis with secondary glaucoma, and lens-induced glaucoma.

Symptoms

Severe unilateral eye pain (often described as worst ever)
Blurred vision and halos around lights
Nausea and vomiting
Frontal headache
Red eye with conjunctival injection
Mid-dilated non-reactive pupil
Corneal edema (hazy/steamy cornea)

Risk Factors

Female gender, age >50
Hyperopia (short eye, narrow angle)
Asian or Inuit descent
Family history of angle-closure glaucoma
Anticholinergic medications, topiramate, decongestants
Pupillary dilation (dim light, stress)
Mature cataract (lens thickening)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden severe eye pain with halos and nausea (EMERGENCY, immediate ER)
  • Acute red eye with vision loss and corneal haze
  • Severe headache with vomiting and red eye
  • After pupil-dilating eye drops with persistent pain
  • Acute vision loss with mid-dilated pupil
  • Suspected angle closure on gonioscopy (prophylactic LPI)
  • Recurrent halos around lights at night

Treatment Methods

01
Immediate IOP reduction: topical timolol 0.5%, brimonidine, pilocarpine 1-2%
02
Systemic carbonic anhydrase inhibitor: oral/IV acetazolamide 250-500 mg
03
Hyperosmotic agents: IV mannitol 1-2 g/kg or oral glycerol (if IOP >50)
04
Topical steroid (prednisolone 1%) for inflammation
05
Definitive: laser peripheral iridotomy (LPI) once cornea clears (within 24-48h)
06
Prophylactic LPI in fellow eye (high risk)
07
Cataract extraction (lens-induced or in mature cataracts)

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Göz Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.