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Closed Angle Glaucoma | Types, Risk Factors & Symptoms

Closed angle glaucoma is caused by a narrow drainage angle in the eye. Here we explore what it is, the two types, risk factors, symptoms and treatment for this condition.

If you have questions about closed angle glaucoma and the treatment options that are available, please call us on 0203 369 2020, or request a call back.

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What is closed angle glaucoma?

Closed angle (angle closure/narrow angle) glaucoma is a type of glaucoma, which is a condition usually associated with a rise in eye pressure. This type of glaucoma results from a narrow drainage angle in the eye. Drainage angle is important because this is how aqueous fluid (which helps the eye keep its spherical shape) is regulated. If drainage angle is narrow, the aqueous outflow is restricted and eye pressure can rise, leading to glaucoma. Closed angle glaucoma generally comes on suddenly and with more obvious symptoms than open angle glaucoma. Closed angle glaucoma is also less common, constituting less than 10% of cases.

Types of closed angle glaucoma

Narrow angle glaucoma can be divided into two main types: primary and secondary. These types are based on whether the closed angle is inherent in the patient’s eye, or whether there is a secondary cause for it.

Primary closed angle glaucoma

Primary closed angle glaucoma is caused by an anatomically narrow drainage angle, with which the patient was born. This can restrict the outflow of the aqueous fluid and cause high eye pressure.

Not everyone who has narrow angles has glaucoma, although by definition it is a risk factor for primary closed angle glaucoma. It can result in a sudden rise in eye pressure, known as acute angle closure glaucoma. This is a medical emergency and treatment should be sought as soon as possible.

Secondary closed angle glaucoma

Secondary closed angle glaucoma can be phacomorphic (enlarged natural lens/cataract), iatrogenic (caused by medications) or caused by trauma. Phacomorphic refers to glaucoma caused by a growing cataract narrowing the drainage angle, resulting in rising eye pressure. Iatrogenic refers to a change in drainage angle caused by medical intervention. This can include certain oral medication or surgical procedures. Trauma to the eye can also lead to glaucoma if the lens is shifted and blocks the drainage angle, or the angle becomes obstructed by blood.

Risk factors for closed angle glaucoma

There are a number of factors which may increase a patient’s chance of developing angle closure glaucoma. These include:

  • Age: glaucoma is more common in older patients
  • Gender: women are more likely to develop closed angle glaucoma than men
  • Family history of glaucoma: someone is more likely to develop the condition if a close family member (a sibling or parent) also has it
  • Long Sightedness (hyperopia): those who are long sighted often have smaller eyes, which makes them more likely to have narrow drainage angles
  • Race: those of Asian origin are more prone to developing closed angle glaucoma

What are the symptoms of closed angle glaucoma?

Unlike open angle glaucoma, a patient with closed angle glaucoma usually experiences symptoms due to the rapid nature of the rise in eye pressure. They will generally have a red and painful eye, as well as blurred vision and halos. The severe pain can cause headaches, nausea and even vomiting. The patient’s pupil may also look distorted. Someone experiencing these symptoms should seek immediate medical attention.

Closed angle glaucoma treatment

Eye drops will initially be used to reduce eye pressure when a patient has closed angle glaucoma. Surgery will then be needed to prevent a future attack.

One option is laser peripheral iridotomy. In this procedure, a YAG laser is used to make a tiny hole in the iris to create a new outflow for aqueous fluid, in turn lowering eye pressure. This treatment takes 10-15 minutes per eye, and both eyes can be treated at the same time if necessary. Generally vision will be blurred and the eye will be red for up to 24 hours after the procedure, but vision should quickly return to normal.

Clear lens extraction (also known as refractive lens exchange) is a surgical procedure which is also used to treat cataracts. It involves removing the natural lens of the eye and replacing it with an artificial lens which is more slim-line, hence permanently opening the drainage angle and reducing eye pressure. The new lens can also remove the need for the patient to wear glasses, as it will correct existing refractive errors, depending on the type of lens chosen.

In younger patients (45 and below), where lens extraction may not be sufficient, filtration surgery will be the treatment option. As the name suggests, this essentially leads to creating a new drainage angle in the eye to lower the pressure. It includes trabeculectomy surgery or tube surgery.

Read more about the different types of glaucoma treatment available here.

If you suffer from glaucoma, or suspect you might have the condition, and would like to discuss potential treatment options, make an enquiry or call on 0203 369 2020