Page 94 - NAME OF CONDITION: REFRACTIVE ERRORS

Cataract surgery alone-helps to reduce crowding of the angle and relative pupillary
block.

Treatment of primary angle closure disease:
PACS
As noted, not all patients of PACS progress to PAC or PACG. The treatment needs to be
individualized in regards to laser iridotomy or a close follow up. An iridotomy may be
considered to reduce the risk of angle closure in future or alternatively the patient may
be monitored for IOP elevation and PAS over time. However an iridotomy can be
considered in the following situations:
 Fellow eye of an eye with primary angle closure

 Confirmed family history of angle closure glaucoma
 Eyes requiring frequent dilation for retinal examination
 When follow up is impractical or a poorly compliant patient
 Symptomatic patient
 Difficulty in opening the angle with compression, with areas of patchy trabecular

meshwork pigmentation
In case iridotomy is deferred, patients are warned about symptoms of angle closure and
are counseled for regular check ups. The possible risk of angle closure by medications
such as decongestants and motion sickness is warned.

PAC and PACG
Laser peripheral iridotomy to relieve pupillary block is recommended as first line
therapy. Appositional or synechial closure of the angle with concomitant damage to
trabecular meshwork can cause rise in IOP. However, medical treatment should not be
used as a substitution of laser in cases of PAC and PACG.
After component of pupillary block has been removed, further management on lines of
open angle glaucomas is done to prevent pressure induced glaucomatous optic
neuropathy and visual field progression by topical hypotensive agents and/or surgery.

Plateau Iris Configuration/ Syndrome
Elimination of element of pupillary block by LPI is recommended as first line of
treatment. Iridoplasty helps opening up non synechial areas of the angle in selected

patients. Chronic use of low dose miotic therapy may prevent further closure of the
angle.

Acute Primary Angle Closure
Initial treatment is medical to lower IOP to a level when definitive therapy by LPI can be
performed.
Medical therapy includes topical hypotensive agents and systemic agents to reduce IOP
rapidly. However, topical mioics may not be effective at times in an ischemic pupillary

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