Date of last review: Due to be updated

Differential diagnosis

  • Neovascular glaucoma
  • Phacolytic glaucoma
  • Phacomorphic glaucoma
  • Acute anterior uveitis
  • Uveitis with raised intraocular pressure
  • Cilio-lenticular block (aqueous misdirection syndrome)

Possible management by Optometrist

Treatment

  • None

Advice

  • Potentially occludable angle as judged by Van Herick test
    • Patients with peripheral anterior chamber width of one quarter or less of the corneal thickness (Van Herick < Grade 2) should be referred
  • Primary Angle Closure Suspect
    • Can only be diagnosed by Gonioscopy
    • The decision to refer for further treatment should be based on the risk of developing primary angle closure / primary angle closure glaucoma or acute angle closure
      • If not referring, monitor closely with serial gonioscopy
    • Patients should be aware that they are at risk of occlusion and that certain medications could induce angle closure
  • Primary Angle Closure/ Primary Angle Closure Glaucoma
    • Refer urgently to ophthalmologist for peripheral iridotomy or lens extraction to relieve pupillary block

Management Category

  • Primary Angle Closure/ Primary Angle Closure Glaucoma
    • Urgent (within one week) referral to ophthalmologist
  • Primary Angle Closure Suspect
    • Routine referral to ophthalmologist

Possible management by Ophthalmologist

  • Peripheral iridotomy
  • Lens extraction