Closed Angle Glaucoma Question

[Spetzler-Martin]

I was wondering if one of you ophthalmologists could answer a question about closed angle glaucoma. My medical school hardly covered this and boards and beyond missed some details as well. Anyways, my question is based on this page from first aid. I was wondering if primary and secondary closed angle glaucoma are considered a part of chronic closed angle glaucoma? First aid appears to have split glaucoma into 4 different subtypes but I'm having trouble differentiating primary and secondary from chronic closure.

---

Members don't see this ad.

 

[salami bahama]

I'll take a stab at this. Glaucoma can be categorized in different ways, but one fairly simple way is to categorize it into 4 categories:

-Primary Open Angle Glaucoma
-Secondary Open Angle Glaucoma
-Primary Angle Closure Glaucoma
-Secondary Angle Closure Glaucoma

Acute angle closure and chronic angle closure can occur in both primary and secondary glaucoma (this is the answer to your question, and FA doesn't clearly show this). No matter the reason the angle becomes blocked off acutely (whether from a primary cause related to their anterior segment anatomy or a secondary cause such as inflammation or neovascularization), if the intraocular pressure spikes from normal (teens) to super high (50-70s), patients can present with a red, painful eye with blurred vision from corneal edema. Same for chronic angle closure. If the angle becomes blocked off typically over a longer period of time from any primary or secondary cause, it is called chronic angle closure. Interestingly, chronic angle closure can lead to similarly high intraocular pressures, but the gradual increase over time doesn't lead to such a dramatic presentation as acute angle closure.

Let me know if that doesn't make sense. It's great you're asking questions about the eye no matter what specialty you go into!

 

[Spetzler-Martin]

I'll take a stab at this. Glaucoma can be categorized in different ways, but one fairly simple way is to categorize it into 4 categories:

-Primary Open Angle Glaucoma
-Secondary Open Angle Glaucoma
-Primary Angle Closure Glaucoma
-Secondary Angle Closure Glaucoma

Acute angle closure and chronic angle closure can occur in both primary and secondary glaucoma (this is the answer to your question, and FA doesn't clearly show this). No matter the reason the angle becomes blocked off acutely (whether from a primary cause related to their anterior segment anatomy or a secondary cause such as inflammation or neovascularization), if the intraocular pressure spikes from normal (teens) to super high (50-70s), patients can present with a red, painful eye with blurred vision from corneal edema. Same for chronic angle closure. If the angle becomes blocked off typically over a longer period of time from any primary or secondary cause, it is called chronic angle closure. Interestingly, chronic angle closure can lead to similarly high intraocular pressures, but the gradual increase over time doesn't lead to such a dramatic presentation as acute angle closure.

Let me know if that doesn't make sense. It's great you're asking questions about the eye no matter what specialty you go into!

Thanks! This was very helpful. Appreciate you taking the time to respond.