Page 89 - NAME OF CONDITION: REFRACTIVE ERRORS

Primary Angle Closure Suspect (PACS)

An angle where more than 180 of the posterior trabecular meshwork cannot be seen under
dim illumination, which, in the presence of normal intraocular pressure and no disc/ field

changes suggestive of glaucoma and no peripheral anterior synechiae is classified as primary
angle closure suspect.
Primary Angle Closure (PAC)
An eye with PACS having peripheral anterior synechiae and/or raised intraocular pressure
with no glaucomatous optic neuropathy is classified as primary angle closure.

Primary Angle Closure Glaucoma (PACG)
An eye with PACS having evidence of glaucomatous damage in the form of glaucomatous

disc changes and/or visual field changes is classified as primary angle closure glaucoma. It is
not mandatory to have raised intraocular pressure or peripheral anterior synechiae.
Secondary Angle Closure

Secondary angle closure occurs from known causes which may or may not be associated

with pupillary block.
Etiology:
Secondary angle closure with pupillary block:

 Swollen lens induced (Phacomorphic)
 Anterior lens subluxation/ dislocation
 Trauma, laxity of zonules, Marfan’s syndrome
 Miotic induced secondary closure
 Miotics relax the ciliary muscle, causing forward movement of iris-lens diaphragm

and may precipitate angle closure.
 Synechiae between iris and crystalline lens/ intraocular lens/cornea/ vitreous
 These cause a physical obstruction to flow of aqueous from the posterior to anterior
chambers and may result in ‘iris bombe’.
 Aphakic pupillary block

Secondary angle closure with anterior pulling mechanism without pupillary block
 Neovascular glaucomas
 Iridocorneal endothelial syndromes

 Inflammation
 Post penetrating keratoplasty
 Epithelial downgrowth
 Aniridia

Secondary angle closure with posterior pushing mechanism without pupillary block
 Ciliary block glaucoma

 Iridociliary cysts
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