Chat Highlights
Closed-Angle Glaucoma
June 6, 2001

Norma Devine, Editor

On Wednesday, June 6, 2001, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Closed-Angle Glaucoma." 

Moderator:  Welcome Dr. Wilson.  The topic tonight is closed-angle glaucoma.  

P:  Why do some people with open angles for many years suddenly suffer acute-angle closure?  

Dr. Rick Wilson:  As we grow older, the lens in the eye that focuses the light on the retina continues to grow.  Since there is so very little room in the eye, the lens material compresses and becomes more dense.  That is one of the reasons we can no longer focus close up as we get older.  The eye also expands somewhat with age, and the pupil becomes smaller.  Both changes have the effect of pushing the iris forward and narrowing the angle further.

P:  Does the debris that clogs the meshwork come from floaters?

Dr. Rick Wilson:  No.  The debris I am talking about is in the front of the eye. Floaters are in the jelly in the back of the eye.

P:  What are the signs of inflammation, and can inflammation cause angle-closure attacks?

Dr. Rick Wilson:  Inflamed eyes are red and the vessels on the surface are dilated. The pupil is usually small and the vision is reduced.  Inflammation can cause the pupil to stick to the lens behind it, and the fluid made in the back of the eye no longer has access to the front of the eye.    The fluid pressure behind the iris pushes the iris into the drain (trabecular meshwork), blocking it.

P:  Could you feel it if the iris stuck to the lens?  

Dr. Rick Wilson:  Normally not until the intraocular pressure starts to increase quickly.  

Moderator:  What makes a person a suspect for developing closed-angle glaucoma?

Dr. Rick Wilson:  A small anterior chamber of the eye, with the space between the iris and the trabecular meshwork very narrow.

P:  I had no visible anterior chamber before all my surgeries.

P:  Does infection cause closed-angle glaucoma?  

Dr. Rick Wilson:  Usually not.  

P:  What about myopia?

Dr. Rick Wilson:  Myopes (people with myopia) have bigger eyes than normal and rarely ever get closed-angle glaucoma without inflammation, tumors or some other less common cause for angle closure.  Hyperopes, those who are far-sighted, have small eyes and are prone to angle closure.

P:   Can hemorrhage cause closed-angle glaucoma? 

Dr. Rick Wilson:  Hemorrhage between the layers of the eye can take up space in the back of the eye and push the iris forward far enough to close off the angle.

P:  You said that the pupil becomes smaller with age.  I have traumatic angle recession in the left eye.  The pupil in that eye is definitely larger than the pupil in my right eye, which has open- angle glaucoma.  Is that normal?

Dr. Rick Wilson:  Often an injury will tear or damage the muscle that causes the pupil to constrict.  Frequently, after trauma the pupil will never constrict to the same extent that it once did.

Moderator:  If the angle is closed for a long time, can that  cause scarring on the lens, iris and/ or cornea?  

Dr. Rick Wilson:  Usually not.  

P:  Would inflammation from seasonal allergies be enough to cause attacks?

Dr. Rick Wilson:  No, but allergy medications can cause angle-closure attacks in susceptible people.

Moderator:  What are the symptoms of a sudden attack of closed-angle glaucoma?  

Dr. Rick Wilson:  An attack of acute-angle closure glaucoma begins with steamy vision, colored rainbow rings around lights, then an eye ache, and a red eye, followed by nausea and possible vomiting.

P:  And the most splitting headache you have ever felt.

P:  What is used to stop the pain?  

Dr. Rick Wilson:  Glaucoma medications.  If you lower the IOP (intraocular pressure), the pain stops. 

P:   Is there something that will lower the IOP quickly?

Dr. Rick Wilson:   Yes, intravenous mannitol.

P:  Am I naive to think that as a normal-tension glaucoma patient I will not get closed-angle glaucoma? 

Dr. Rick Wilson:  I can't think of a normal-tension glaucoma patient who suffered angle closure glaucoma.  Theoretically, however, it should be easily possible.

P:  Is it common for patients to have both open- and closed-angle glaucoma?

Dr. Rick Wilson:  No.  But it is possible for a patient with narrow angles and open-angle glaucoma to develop some angle closure (combined-mechanism glaucoma).

P:  For many years I was told I had mixed-mechanism glaucoma -- both open- and closed-angle.  Now my doctor says I have only open-angle glaucoma.  Is that possible?

Dr. Rick Wilson:  If you did not have an iridectomy or other procedure to open the angle, you probably don't have only open-angle glaucoma.  It doesn't really matter what is clogging the trabecular meshwork or drainage system.  In primary-angle closure, it is the patient's own iris.  In open-angle glaucoma,  probably debris and possibly collapse of the structure are clogging the meshwork.  In inflammatory glaucoma,  the white cell debris and thicker nature of the watery fluid in the anterior chamber of the eye are clogging the meshwork. 

P:  Thank you very much Dr. Rick.  The things I have learned here are amazing.

P:  Thanks again, Dr. Rick, for a very informative evening.

Dr. Rick Wilson:  You're welcome.  Have a great week everyone.

Illustrations Copyright 2003 Tim Peters and Company, Inc. Peapack NJ 07977 USA. All Rights Reserved. www.timpetersandcompany.com

End of chat highlights for June 6, 2001.

Note: The chat highlights for June 7, 2000, also contain information about angle-closure glaucoma. 

On June 11, Dr. Henderer met with the Monday night support group.  Click here for highlights of that meeting.

Click here for the most recent glaucoma chat highlights and links to the chat archives.

Click here for upcoming glaucoma chat events.