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- Medically Reviewed by Mr Mfazo Hove Consultant Ophthalmologist
- Author: Chris Dunnington
- Published: November 24, 2024
At Blue Fin Vision®, our premier eye clinic on Harley Street in London, we often encounter patients with various types of glaucoma. Among these, Acute Closed Angle Glaucoma (ACAG) is one of the most urgent and potentially sight-threatening conditions. In this comprehensive guide, we’ll explore what ACAG is, its causes, symptoms, and the cutting-edge treatments available.
Understanding Acute Closed Angle Glaucoma
Acute Closed Angle Glaucoma, also known as Acute Angle Closure Glaucoma, is a sudden and severe form of glaucoma characterised by a rapid increase in intraocular pressure (IOP). This occurs when the drainage angle in the eye becomes blocked, preventing the proper outflow of aqueous humour, the fluid that maintains the eye’s shape and pressure.
Key Facts About ACAG:
- It’s a medical emergency requiring immediate treatment
- Can cause permanent vision loss if not treated promptly
- Typically affects one eye at a time
- More common in older adults and people of Asian descent
- Often occurs in people who are long-sighted (hyperopic)
Causes of Acute Closed Angle Glaucoma
Understanding the causes of ACAG is crucial for early detection and management. Several factors contribute to its development:
- Anatomical Predisposition
Some people have a naturally narrow drainage angle, which increases their risk of ACAG. This is more common in:
- People of Asian descent
- Individuals with hyperopia (long-sightedness)
- Those with a family history of angle-closure glaucoma
- Pupil Dilation
When the pupil dilates, it can cause the iris to bunch up and block the drainage angle. This can occur due to:
- Dim lighting conditions
- Emotional stress
- Certain medications (e.g., some antidepressants, antihistamines, and decongestants)
- Age-Related Changes
As we age, the lens of the eye becomes larger, which can push the iris forward and narrow the drainage angle.
- Other Factors
- Certain eye conditions (e.g., cataracts, eye tumours)
- Previous eye surgery
- Inflammation in the eye
At Blue Fin Vision®, our experienced ophthalmologists conduct thorough assessments to identify any underlying factors that may contribute to ACAG.
Symptoms of Acute Closed Angle Glaucoma
Unlike some other forms of glaucoma, ACAG presents with sudden and severe symptoms. It’s crucial to recognise these signs and seek immediate medical attention:
- Severe eye pain, often described as feeling like a deep ache in the eye
- Sudden onset of blurred or foggy vision
- Seeing halos or rainbow-coloured rings around lights
- Redness in the eye
- Nausea and vomiting (due to the severe pain)
- Headache, particularly around the eye or on the same side of the head
- Sudden decrease in vision
It’s important to note that these symptoms can come on very quickly, often in the evening or in dim light when the pupil is more dilated.
Diagnosing Acute Closed Angle Glaucoma
At our London eye clinic, we use state-of-the-art diagnostic tools to accurately identify and assess ACAG:
- Tonometry: Measures intraocular pressure, which is typically very high in ACAG.
- Gonioscopy: Examines the drainage angle of the eye using a special lens.
- Slit-lamp Examination: Allows detailed examination of the eye’s structures.
- Ophthalmoscopy: Examines the optic nerve for signs of damage.
- Visual Acuity Test: Checks for any vision loss.
Early diagnosis is key to preventing permanent vision loss and implementing effective treatment strategies.
Treatment Options for Acute Closed Angle Glaucoma
ACAG is a medical emergency that requires immediate treatment to lower the intraocular pressure and prevent permanent vision loss. At Blue Fin Vision®, we offer a range of advanced treatments:
- Immediate Medical Treatment
The first step is to lower the eye pressure quickly using:
- Eye drops: To constrict the pupil and improve drainage
- Oral or intravenous medications: To reduce fluid production in the eye
- Pain relief: To manage the severe discomfort associated with ACAG
- Laser Treatment
Once the pressure is under control, laser treatment is typically performed:
- Laser Peripheral Iridotomy (LPI): Creates a small hole in the iris to improve fluid drainage
- This is usually done on both eyes, as the unaffected eye is at high risk of developing ACAG in the future
- Surgical Intervention
In some cases, surgery may be necessary:
- Trabeculectomy: Creates a new drainage channel for aqueous humour
- Lens Extraction: Removing the natural lens (especially if cataracts are present) can help open the drainage angle
- Preventive Measures
For the unaffected eye or for those at high risk:
- Prophylactic Laser Iridotomy: To prevent an acute attack in the other eye
- Regular monitoring: To check for signs of angle closure
Living with Acute Closed Angle Glaucoma
After an episode of ACAG, ongoing management is crucial:
- Regular Follow-ups: Frequent eye check-ups to monitor pressure and overall eye health
- Medication Adherence: Using prescribed eye drops to maintain healthy eye pressure
- Lifestyle Modifications: Avoiding triggers like certain medications and prolonged exposure to dim lighting
- Awareness: Being vigilant for symptoms in the unaffected eye
Prevention of Acute Closed Angle Glaucoma
While not all cases of ACAG can be prevented, certain measures can reduce your risk:
- Regular Eye Exams: Especially important if you’re over 40 or have risk factors
- Know Your Family History: Be aware if angle-closure glaucoma runs in your family
- Be Cautious with Medications: Discuss potential eye-related side effects with your doctor
- Proper Lighting: Avoid spending long periods in dim lighting, especially if you’re at risk
Why Choose Blue Fin Vision® for ACAG Care?
At Blue Fin Vision®, our Harley Street clinic offers:
- Expert Care: Our team of specialist ophthalmologists are leaders in diagnosing and treating acute glaucoma.
- Advanced Technology: We use the latest diagnostic and treatment technologies for optimal outcomes.
- Emergency Services: We understand the urgency of ACAG and provide prompt care when needed.
- Personalised Treatment: Each patient receives a tailored care plan based on their specific condition and needs.
- Comprehensive Support: From acute management through to long-term care, we provide continuous support.
Conclusion: Taking Control of Your Eye Health
Acute Closed Angle Glaucoma is a serious condition that requires immediate attention. At Blue Fin Vision®, we’re committed to providing the highest standard of care for ACAG patients, utilising the latest advancements in eye care to preserve your vision and improve your quality of life.
If you’re experiencing any sudden changes in vision, severe eye pain, or are concerned about your risk of glaucoma, we urge you to seek immediate medical attention. For non-emergency eye care and comprehensive glaucoma management, we invite you to book an appointment at our London eye clinic.
Remember, your eye health is precious, and early detection and treatment can make all the difference in preserving your vision. Trust the experts at Blue Fin Vision® to provide comprehensive, state-of-the-art care for all your eye health needs, including the management of Acute Closed Angle Glaucoma. Contact us today to schedule your eye examination and take the first step towards protecting your vision for years to come.
