Primary angle-closure glaucoma (JPZK) is not the most common form of this disease in Europe. It is estimated that different forms of JPZK together account for only 5-6 percent of glaucoma cases in Poland and Europe (approximately in 1 person in 1000 after 40 years of age). Women suffer from this form of glaucoma much more often.

Angle-closure glaucomacovers a large group of disease entities that can have different symptoms and are treated with different treatments. A common feature of all types of JPZK is an increase in pressure in the eye, the subsequent atrophy of the optic nerve and the associated blindness. In order to treat this type of glaucoma properly, the doctor must carefully examine the patient and perform a series of additional tests and observations. Very important in this type of glaucoma is an early diagnosis and prompt implementation of appropriate treatment. If the conditions are met, it is very often possible to stop the progression of the disease completely.

Primary angle-closure glaucoma (JPZK): symptoms

Angle closure is a condition defined as the contact of the peripheral part of the iris with the trabecular structure, obstructing the outflow of aqueous humor through the anterior chamber angle. In all types of angle-closure glaucoma, symptoms may vary in intensity, ranging from slight to very severe, depending on how much pressure in the eye has built up. They are:

  • eyeball pain
  • headache
  • blurred, hazy vision, sometimes seeing rainbow circles around light sources
  • eye redness and tearing
  • nausea and vomiting

In my practice, I most often encounter 2 causes of angle closure which can lead to glaucomatous damage to the optic nerve. These are the pupillary block and phacomorphic glaucoma.

See how to recognize glaucoma

Pupillary Block

Pupillary block is the most common cause of angle closure in young people. It consists in blocking the flow of aqueous humor through the pupil due to the innate, specific structure of the eye. These patients most often have small eyeballs and hyperopia (plus distance glasses). This type of glaucoma is more common in women, usually the first symptoms appear around the age of 40. Due to the genetic makeup, the doctor should askattention to family history and the incidence of this disease in close relatives.

If there is a rapid increase in closure symptoms, there is a sharp, primary angle closure, i.e. an acute attack of glaucoma.

If the pressure remains high for a long time, irreversible changes in the eye and optic nerve may occur

Symptoms are then very severe and it is necessary to immediately start treatment. Since the pressure in the affected eye can reach up to 50 mmHg, and sometimes even higher, the optic nerve may be damaged in a short time. To stop this type of glaucoma attack, your doctor must give you the correct eye pressure medication. These can be drugs in the form of eye drops as well as oral or intravenous. Then a laser iridotomy procedure should be performed to unblock the closed angle. If the treatment is not effective, surgical treatment should be considered.

Unfortunately, patients often ignore unpleasant symptoms, hoping that they will pass on their own, or instead of going to an ophthalmologist, because of headaches and vomiting, they go to neurology or internal medicine departments, and it takes a long time to make a proper diagnosis.

Phacomorphic glaucoma (cataract with swelling of the lens)

In the elderly (over 60 years of age) with a specific eye structure and usually a narrow viewing angle, cataract formation may cause an enlargement of the anteroposterior dimension of the lens (the so-called swelling of the lens). The enlarged lens pushes the iris forward and closes the drainage angle.

In this sharp angle closure, symptoms also tend to increase rapidly, although they can vary in severity. The symptoms resemble an acute attack of glaucoma, as seen in younger people, but the treatment is slightly different. The most important thing is to quickly lower the pressure in the eye (drops, general medications), but laser iridotomy does not seem to be as effective as in younger people and its advisability is widely discussed. A more effective procedure is to remove the cataract, even if it is in a very early stage, and sometimes to perform an additional anti-glaucoma treatment.

Treatment of angle-closure glaucoma

However, in order for the patient to be properly treated, an earlier, detailed diagnosis is necessary. The basic tests that must be performed include, of course, measuring the pressure in the eyeballs, examining the anterior segment of the eyeballs, but also assessing the optic nerve in a slit lamp examination (using a special lensVolka) and performing HRT laser tomography, examining the layer of GDx retinal nerve fibers, measuring the thickness of the layer of GCL retinal ganglion cells and performing a visual field examination, preferably using FDT technology.

It is also very important to assess the traversing angle of the anterior chamber, its width and the presence of any adhesions, which is performed using a special gonioscopic lens and the newer AS-OCT laser tomography technology.

In the prevention and treatment of angle-closure glaucoma, prophylaxis is also very important, consisting in an ophthalmological inspection at least once a year in people feeling full he alth. When examining the patient, the doctor may determine the presence of a narrow angle and the risk of the angle closing. In such cases, if the identified risk is high, a prophylactic laser iridotomy should be performed to prevent future closure of the angle. Even if for some reason the laser treatment has not been performed, the patient is aware that the pressure may increase and he should not underestimate any symptoms.

And one more thing. The patient's family should also undergo preventive examinations for glaucoma, with particular emphasis on the assessment of the width of the anterior chamber angle.

Glaucoma - treatments for glaucoma

Depending on the severity of the disease, glaucoma can be treated with different methods. Starting from specially dedicated sets of drops to operating methods. What treatment method has the best results? When do we use non-surgical treatment and when is surgery necessary? Our expert, prof. Iwona Grabska-Liberek, head of the department of ophthalmology at the Clinical Hospital W. Orłowski in Warsaw

About the authorBarbara Polaczek-Krupa, MD, PhD, specialist in eye diseases, Centrum Opulystowa Targowa 2, Warsaw

Dr. Barbara Polaczek-Krupa, MD, initiator and founder of the T2 Center. She specializes in modern diagnostics and treatment of glaucoma - this was also the subject of her PhD thesis defended with honors in 2010.

Dr. med. Polaczek-Krupa has been gaining experience for 22 years, since she started working at the Ophthalmology Clinic of CMKP in Warsaw, with which she was associated in 1994-2014. During this period, she obtained two degrees of specialization in ophthalmology and the title of doctor of medical sciences.

In the years 2002-2016 she worked at the Institute of Glaucoma and Eye Diseases in Warsaw, where she gained knowledge and medical experience by consulting patients from all over Poland and abroad.

For years, as part of cooperation with the Medical Center of Postgraduate Educationlecturer at courses and training for doctors specializing in ophthalmology and primary he alth care.

He is the author or co-author of numerous publications in scientific journals. Member of the Polish Ophthalmology Society (PTO) and the European Glaucoma Society (EGS).

Category:

Eye diseases and vision disorders