Angle Closure Glaucoma

Overview

Angle closure glaucoma is a serious eye condition where the fluid inside the eye cannot drain properly, causing a sudden and dangerous rise in pressure. This pressure can damage the optic nerve and lead to vision loss if not treated quickly.

Angle closure glaucoma is less common than open-angle glaucoma, but it is a leading cause of blindness in some parts of the world.

It can affect anyone, but it is more common in people of East Asian or Inuit descent, in women, and in people over age 60. People who are farsighted (long-sighted) also have a higher risk.

Symptoms

Common symptoms

• Severe eye pain
• Blurred vision or sudden vision loss
• Seeing halos (rainbow-coloured circles) around lights
• Redness in the eye
• Headache, often on the same side as the affected eye
• Nausea or vomiting

Symptoms in children

• Angle closure glaucoma is very rare in children, but similar symptoms can appear in infancy.
• Cloudy or hazy cornea (the clear front part of the eye)
• Excessive tearing
• Sensitivity to light
• The eye may look larger than normal

Symptoms in older adults

• Older adults may have less obvious symptoms and might mistake them for migraines or stomach upset.
• Sudden severe eye pain with blurred vision
• Seeing halos around lights
• Redness in the eye with nausea or vomiting

Causes

Main causes

• The eye naturally produces a fluid called aqueous humour that normally drains through a structure called the drainage angle.
• In angle closure glaucoma, the iris bulges forward and blocks this drainage angle.
• When the fluid cannot drain, pressure inside the eye builds up rapidly, damaging the optic nerve.

Risk factors

• Being over age 60
• Being female
• Being of East Asian, Southeast Asian, or Inuit descent
• Having long-sightedness (hyperopia)
• Having a family history of angle closure glaucoma
• Taking certain medicines, such as cold remedies or antidepressants, that widen the pupil

When to see a doctor

See a doctor urgently if:

• Call your local emergency number immediately if you have sudden severe eye pain, blurred vision, halos around lights, redness, or nausea and vomiting.
• Seek same-day medical care if you have intermittent or mild symptoms that come and go.

Book a routine appointment if:

• Have regular eye exams, especially if you have risk factors for narrow angles.
• Ask your doctor for a comprehensive eye exam if you have not had one recently.

Diagnosis

Angle closure glaucoma is diagnosed through a comprehensive eye examination performed by an eye specialist (ophthalmologist or optometrist). They will measure your eye pressure, inspect the drainage angle, and examine your optic nerve.

Tests that may be done

• Tonometry: a quick test that measures the pressure inside your eye
• Gonioscopy: a special lens to look at the drainage angle and see if it is narrowed or blocked
• Slit-lamp examination: a microscope to examine the front parts of your eye
• Ophthalmoscopy: a device to look at the optic nerve at the back of your eye
• Visual field test: to check for any areas of vision loss

What to expect at your appointment

The eye examination is usually painless. You may receive numbing eye drops and drops to widen your pupils. Your vision may be blurry for a few hours afterward, so it is a good idea to have someone with you if possible. In an acute attack, the examination is done as an emergency.

Treatment

Treatment for angle closure glaucoma focuses on lowering eye pressure immediately to protect the optic nerve, and then preventing future attacks. The most common and effective treatment is a laser procedure called laser iridotomy, which creates a tiny hole in the iris to allow fluid to drain.

Self-care at home

• Do not rub or press on your eye.
• Take all prescribed eye drops exactly as your doctor tells you.
• Attend all follow-up appointments with your eye specialist.
• If you have had an acute attack, ask your pharmacist or doctor before taking any new medicines, especially cold, allergy, or motion-sickness products.
• Avoid spending long periods in dark rooms, as dim light can widen the pupil and trigger an attack.

Medical treatments

Medical treatment generally uses prescription eye drops, oral tablets, or intravenous medications given in a hospital to lower eye pressure rapidly. These treatments are temporary steps to control an acute attack. Your eye specialist will then recommend laser or sometimes surgery to fix the underlying drainage problem.

When is surgery considered?

Laser iridotomy is the standard surgery for angle closure glaucoma. It is a quick, usually painless outpatient procedure that creates a bypass opening in the iris. In some cases, cataract surgery may be recommended if the lens of the eye is contributing to the narrow angle.

Living with this condition

After treatment, most people can live full and active lives. You will need regular check-ups, usually once or twice a year, to monitor your eye pressure and optic nerve health. Keep a written list of your eye medicines and bring it to every appointment.

Lifestyle tips

• Avoid rubbing or pressing on your eyes.
• Wear protective eyewear when doing tasks that could injure your eyes.
• Tell your eye specialist about any new medicines, including over-the-counter products.
• Avoid dark, dimly lit environments if you have been told you have narrow angles.
• Wear sunglasses outdoors if bright light bothers your eyes after treatment.

Diet and exercise

A balanced diet and regular exercise are good for your overall health and may support eye health. There is no special diet that treats angle closure glaucoma, but staying active, drinking water, and avoiding smoking can help.

Mental health and emotional wellbeing

A glaucoma diagnosis can be stressful and worrying. You may feel anxious about your vision or independence. These feelings are normal. Talk openly with your healthcare team, and reach out to a counsellor or support group if you feel overwhelmed.

Prevention

Once a narrow drainage angle is detected, a preventive laser iridotomy can often stop an acute attack from happening. If you have risk factors, a routine eye exam can identify a narrow angle before symptoms appear.

Screening programmes

Regular comprehensive eye exams are the best way to detect narrow angles early. If you are over 60 or have other risk factors, consider an eye exam every 1–2 years, or as advised by your eye care professional.

Complications

If left untreated

• Permanent vision loss in the affected eye
• Optic nerve damage due to severely high eye pressure
• Scarring inside the drainage angle, making future glaucoma harder to control

Long-term outlook

With prompt treatment, vision loss from a first attack is often limited. Laser iridotomy can prevent future attacks and protect your sight. Most people retain useful vision for life, especially when they keep regular follow-up appointments and manage their eye health carefully.

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