Closed-angle glaucoma is a sight-threatening emergency that requires immediate action. If you're experiencing symptoms like severe eye pain or blurred vision, contact our experienced specialists right away to preserve your vision.
Closed-angle (angle-closure) glaucoma is not just a “serious” eye problem; it is a true medical emergency. When the eye’s drainage angle suddenly closes, intra-ocular pressure can skyrocket within hours, permanently damaging the optic nerve and stealing vision.
If you develop any of the following without warning: sudden, intense eye pain or headache, blurred vision or halos around lights, reddened eye, nausea, or vomiting
Do NOT wait for an appointment: go immediately to the nearest emergency room or call 911.
If your symptoms are milder or you’ve been told you’re at risk for angle closure, call our office right away; we will arrange an urgent, same-day evaluation. Fast action, whether with us or in the ER, can be the difference between preserving and losing sight.
When the eye’s drainage angle shuts abruptly, fluid backs up and eye pressure rises in minutes to hours. This is an emergency, untreated, vision can be lost in a single day. If you notice any of the symptoms below, call an available eye doctor or go to the nearest emergency department right away.
A sharp, deep ache that appears out of nowhere. Patients often describe it as “the worst eye pain I’ve ever felt,” sometimes radiating to the brow or temple.
Vision suddenly becomes hazy, as if looking through frosted glass. You may also notice that printed words or faces lose their crispness.
Bright lights (car headlights, streetlamps) appear with rainbow-colored rings around them, especially in dim settings or at night.
The white of the eye turns blood-shot because of the rapid pressure rise and inflammation inside the eye.
A pounding headache, often centered on the same side as the affected eye, can mimic a migraine.
The severe eye pain and headache can upset the stomach, leading to queasiness or vomiting similar to motion sickness.
If pressure stays high, peripheral (side) vision can disappear first, followed by central vision. Acting quickly can prevent this permanent damage.
Sometimes the drainage angle narrows little by little. Pressure creeps up quietly, causing damage over months or years. Because the changes are subtle, regular comprehensive eye exams are critical for early detection.
A dull pressure sensation that comes and goes, often mistaken for eye strain after reading or screen time.
Short spells of hazy sight, especially in dim lighting, may clear on their own but signal narrowing of the angle.
Objects at the edge of your field of view start to disappear. Many people compensate by turning their head, so the change may go unnoticed at first.
A low-grade, nagging headache located above or around the eyes, often worse in the evening.
Unfortunately, some eyes give no warning at all. This “silent thief of sight” makes routine eye pressure checks and optic nerve evaluations essential, especially if you have a family history of glaucoma or belong to a higher-risk group (e.g., age > 40, Asian descent, or farsighted).
Closed-angle glaucoma happens when the front part of your eye, the iris and cornea, come too close and block the normal drainage pathway for eye fluid (called aqueous humor). This blockage causes fluid to build up quickly inside the eye, raising the pressure to dangerous levels. Although this type of glaucoma is rare (about 1 in 1,000 people), it can cause sudden and permanent vision loss, especially in people over 40 and more commonly between ages 60 and 70. If you have “narrow angles,” it means you’re at risk but don’t have glaucoma yet. Early detection allows for simple treatments, like laser therapy, to prevent the condition.
Think of your eye’s drainage system as a narrow channel. When the iris moves too close and blocks this channel, fluid can’t flow out properly, causing pressure to rise quickly. This pressure buildup damages the optic nerve, which can lead to vision loss if not treated immediately.
In this common cause, the iris and the lens press tightly together, causing the iris to bulge forward, sometimes called “iris bombe.” This pushes the iris to seal off the drainage angle, leading to a sudden increase in eye pressure. Imagine a door closing and blocking a hallway that fluid normally flows through.
Sometimes, even if the center of the eye looks open, the edges where the fluid drains remain very narrow because of the iris or ciliary body’s shape. Small changes like pupil dilation (when your eye opens wider in low light) can quickly cause the angle to close, triggering a sudden pressure rise.
Other eye conditions can also push or pull the iris to block drainage. For example, inflammation inside the eye (uveitis), swelling of the eye’s lens (phacomorphic glaucoma), or new abnormal blood vessels growing inside the eye (seen in diseases like diabetic retinopathy) can cause the iris to block the drainage angle.
Closed-angle glaucoma is a rare but serious condition that can cause rapid and permanent vision loss. Recognizing your risk factors helps ensure early diagnosis and prevention. Here’s a comprehensive list to help you understand who is at higher risk.
The risk increases significantly after age 55, especially between 60 and 70 years old. This is mainly because the natural lens in the eye thickens with age, narrowing the drainage angle.
If glaucoma runs in your family, your chance of developing closed-angle glaucoma is higher due to inherited eye anatomy that predisposes you to angle closure.
People of Asian and Inuit descent are more likely to have shallow front eye chambers and narrow drainage angles, increasing their risk.
Women are two to three times more likely to develop closed-angle glaucoma. This is partly due to naturally smaller eyes and shallower anterior chambers compared to men.
People who are farsighted often have shorter eyeballs, resulting in shallower anterior chambers and narrower angles, which can increase risk.
A narrow anterior chamber angle, thickened lens, or abnormal iris shape (like plateau iris syndrome) can block fluid drainage. Changes like lens swelling from cataracts can worsen this narrowing.
Conditions such as diabetic retinopathy, uveitis (eye inflammation), ocular ischemia (reduced blood flow), ocular tumors, or ectopic lenses (displaced lenses) can cause secondary angle closure by pushing or pulling the iris into the drainage angle.
Certain drugs can dilate your pupils or change eye anatomy, increasing the risk of an acute angle closure attack. Common examples include antihistamines, cold remedies, antidepressants, sulfonamides, topiramate (used for migraines or seizures), and phenothiazines.
Situations that cause your pupils to dilate suddenly, like being in low light, stress, or after taking certain medications, can trigger angle closure by narrowing the drainage angle abruptly.
A history of eye trauma or certain eye surgeries can alter the eye’s internal structure, increasing the risk of angle closure glaucoma.
Some people have anatomically narrow angles without symptoms (called "narrow angles"), which places them at ongoing risk. Without treatment, these can develop into angle-closure glaucoma over time.
Closed-angle glaucoma accounts for about 10-20% of glaucoma cases worldwide but is more common in Asia and Inuit populations. This reflects variations in eye anatomy across ethnicities.
Conditions causing reduced blood flow in the eye (ocular ischemia) may contribute to angle closure by altering the iris or surrounding tissues.
As cataracts develop, the lens can swell and push the iris forward, further narrowing the drainage angle and increasing risk of acute closure.
Diagnosing closed-angle glaucoma starts with a careful review of your symptoms paired with a thorough eye examination. Since the acute form presents rapidly and severely, the diagnosis is largely clinical. During an exam, our glaucoma specialists will check for:
If you're experiencing symptoms of closed-angle glaucoma, don’t hesitate to reach out for urgent care. Our expert glaucoma specialists, including Dr. Smith and Dr. Johnson, are ready to provide you with immediate evaluations and personalized treatment options to protect your vision.
A rapid and significant increase in IOP is a key indicator, often showing values of 40 mm Hg or more in acute cases.
Cloudiness in the cornea is common due to the high pressure, which can affect the accuracy of certain diagnostic tests.
A fixed and mid-dilated pupil, which does not react well to changes in light, is another sign.
This specialized exam helps in visualizing the drainage angle directly, confirming if it is narrow or completely closed, and detecting peripheral anterior synechiae (adhesions) that may have formed.
Because closed-angle glaucoma can lead to permanent vision loss very quickly, prompt treatment is essential. The primary goal is to lower the intraocular pressure as rapidly as possible and to reopen the blocked drainage pathway. Our glaucoma specialists employ several treatment methods depending on the severity and specific details of each case.
If you are diagnosed with an acute attack, immediate intervention typically includes the use of medications to reduce IOP:
Once the intraocular pressure is under control, laser therapy becomes a critical component of definitive treatment. The most common procedure is laser peripheral iridotomy (LPI). During this procedure, a laser is gently applied to create a tiny hole in the iris. This opening improves fluid flow from the posterior to the anterior chamber, effectively relieving the pupillary block. In many cases, our glaucoma specialists recommend performing LPI in both eyes because the fellow eye is at high risk for developing a similar episode.
For patients who are not ideal candidates for laser therapy, or in cases where the pressure remains uncontrolled, surgical intervention may be necessary. Surgical procedures such as trabeculectomy, which involves creating a new drainage channel, are considered in more advanced or refractory cases. Additionally, in some instances, suprachoroidal shunts may be implanted to assist with fluid drainage in moderate to severe situations.
Each treatment is tailored to the individual’s condition, ensuring that the approach is both effective and safe. Given the urgency associated with acute episodes, our glaucoma specialists work swiftly and meticulously to restore normal eye pressure and prevent further damage.
The key to managing closed-angle glaucoma is early detection and intervention, especially for those identified as high-risk due to anatomical considerations. The profound impact this condition can have on vision makes screening a critical component of eye care, particularly for individuals with narrow angles, family history, or those belonging to higher risk ethnic groups.
Regular exams that include gonioscopy ensure that any narrowing of the drainage angle is detected early. This is particularly important for people over 55 or those with a family history of glaucoma.
If you are at risk, avoiding medications known to cause significant pupil dilation can help prevent an acute attack. Inform our eye doctor if you have a history of narrow angles before starting new medications.
For individuals with significantly narrow angles even before symptoms develop, a prophylactic LPI might be recommended. This preemptive measure can greatly reduce the risk of a sudden angle closure.
Recognizing early warning signs and understanding the risks associated with closed-angle glaucoma empowers patients and encourages them to seek timely care.
By taking these steps, many individuals can prevent the onset of an acute episode and maintain better overall eye health. Remember that closed-angle glaucoma is an emergency, and prompt intervention is necessary to preserve vision long-term.
When you come in for a consultation regarding closed-angle glaucoma, you can expect our glaucoma specialists to evaluate your medical history, symptoms, and risk factors thoroughly. The exam typically involves familiar tests, such as measuring intraocular pressure, assessing the clarity of the cornea, and performing gonioscopy to inspect the drainage angle. These procedures help to pinpoint the exact nature of the blockage and distinguish whether the condition is acute, intermittent, or has a chronic component.
During an acute episode, immediate treatment is initiated to lower the eye pressure. This may involve a combination of eye drops, systemic medications, and urgent laser procedures like LPI. Our glaucoma specialists will carefully explain the role of each treatment, the likely timeline for symptom improvement, and the importance of continued monitoring.
For patients undergoing prophylactic procedures, the benefits far outweigh the risks. A laser peripheral iridotomy is a relatively quick procedure that offers substantial protection against potential future attacks. While there may be minor side effects such as temporary glare, most individuals recover comfortably and resume normal activities shortly after the treatment.
Managing closed-angle glaucoma is a collaborative effort between you and our glaucoma specialists. Following an acute episode, it is important to adhere to the prescribed treatment regimen and attend all follow-up appointments. Ongoing management may include periodic eye pressure checks and examinations to ensure that the drainage angle remains open and that no further damage has occurred.
For patients in the chronic phase or those with intermittent symptoms, lifestyle adjustments and close monitoring are key. Understanding what triggers an episode, whether it’s specific medications, changes in lighting, or anatomical factors, can help in minimizing the risk of a recurrence. Open communication with our glaucoma specialists allow for adjustments in your care plan as needed, ensuring that your vision is preserved and the condition remains under control.
In addition, our glaucoma specialists will work with you to manage any other health conditions that might influence your eye health. For instance, controlling diabetic retinopathy, managing systemic blood pressure, or addressing inflammatory conditions can play an integral role in mitigating the risk of a closed-angle attack. This comprehensive approach is designed to maintain both your overall health and the well-being of your eyes.
Yes. Even after laser or surgery, you should continue regular eye exams, as rare re-closure or new problems can occur.
The best prevention is regular eye exams, especially if you have risk factors. Prophylactic laser is recommended in certain high-risk patients.
Yes, family history increases your risk. Encourage relatives to have eye exams.
No, closed-angle glaucoma and open-angle glaucoma are two different types of glaucoma. While both conditions lead to elevated intraocular pressure, closed-angle glaucoma is caused by a sudden blockage of the eye's drainage angle, whereas open-angle glaucoma is a more gradual condition where the drainage system is less effective over time. Closed-angle glaucoma is an acute emergency, while open-angle glaucoma usually develops slowly without immediate symptoms.
Not all patients with closed-angle glaucoma require surgery. Many patients can be treated effectively with laser peripheral iridotomy (LPI) or medications to reduce intraocular pressure. However, in cases where the angle is difficult to open, or pressure remains high despite laser therapy, surgical options such as trabeculectomy or suprachoroidal shunt implantation may be necessary to create a new drainage pathway.
If you're experiencing symptoms of closed-angle glaucoma, don’t hesitate to reach out for urgent care. Our expert glaucoma specialists, including Dr. Smith and Dr. Johnson, are ready to provide you with immediate evaluations and personalized treatment options to protect your vision.
Closed-angle glaucoma is a serious condition that can lead to vision loss. Contact our top specialists for urgent evaluation and treatment options.
