Page 95 - NAME OF CONDITION: REFRACTIVE ERRORS

sphincter. Indentation with a 4 mirror gonioscope or a cotton tipped applicator has been
used to break the acute attack. Laser iridectomy of the affected eye is the definitive

management. It is done along with prophylactic iridectomy of the fellow eye, if narrow.
This is done as nearly 50% of fellow eyes have been reported to develop acute closure

within 5 years of the fellow eye. Following LPI, reassessment of the angles by gonioscopy
is done to determine extent of synechial closure. IOP is controlled by antiglaucoma
medications and optic nerve head damage and visual field assessment is done to outline
further management. In case of extensive synechial closure, incisional surgery for
glaucoma can be considered for IOP control, although it carries a high risk of post
operative complications such as shallow anterior chamber and malignant glaucoma.
Treatment of secondary angle closure glaucomas:
The treatment of secondary glaucomas is directed to the primary event causing angle

closure which is based on the underlying mechanism of angle closure—pupillary block,
or non pupil block (anterior pulling/ posterior pushing) mechanisms.

Thus, treatment of secondary glaucomas may require relief of pupil block (iris bombe/
lens induced) with YAG peripheral iridectomy and treatment of underlying in
inflammatory disorder. Raised IOP is treated with topical/ oral antiglaucoma
medications as needed.

Standard Operating procedure
a) In Patient
 Acute primary angle closure unresponsive to medical therapy/lasers

 Lens induced (Phacomorphic glaucoma)
 Symptomatic secondary angle closure requiring hyperosmotics for IOP control
b) Out Patient
 PACS, PAC, PACG, Secondary glaucomas
 Acute primary angle closure (following laser iridotomy and the patient is
asymptomatic)

c) Day Care
 Not applicable

d) Referral criteria:

immediate referral on presentation if there is
Acute primary angle closure with uncontrolled IOP on maximum therapy and facilities
for laser peripheral iridotomy are not available
Facilities for cataract surgery not available in lens induced glaucomas (phacomorphic)
Children (acute intraocular pressure lowering measures initiated prior to referral; laser
or surgical therapy to be done at higher centres)

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