This guideline last updated 07/05/2022 9:31:29

Differential diagnosis

• Neovascular glaucoma
• Phacolytic glaucoma
• Phacomorphic glaucoma
• Acute anterior uveitis
• Uveitis with raised intraocular pressure
• Cilio-lenticular block (aqueous misdirection syndrome)

Possible management by Optometrist

Treatment

• None

Advice

• Potentially occludable angle as judged by Van Herick test
  • Patients with peripheral anterior chamber width of one quarter or less of the corneal thickness (Van Herick < Grade 2) should be referred
• Primary Angle Closure Suspect
  • Can only be diagnosed by Gonioscopy
  • The decision to refer for further treatment should be based on the risk of developing primary angle closure / primary angle closure glaucoma or acute angle closure
    • If not referring, monitor closely with serial gonioscopy
  • Patients should be aware that they are at risk of occlusion and that certain medications could induce angle closure
• Primary Angle Closure/ Primary Angle Closure Glaucoma
  • Refer urgently to ophthalmologist for peripheral iridotomy or lens extraction to relieve pupillary block

Management Category

• Primary Angle Closure/ Primary Angle Closure Glaucoma
  • Urgent (within one week) referral to ophthalmologist
• Primary Angle Closure Suspect
  • Routine referral to ophthalmologist

Possible management by Ophthalmologist

• Peripheral iridotomy
• Lens extraction