Angle-Closure Glaucoma Treatment
Acute angle closure is a true ocular emergency requiring immediate pressure-lowering treatment, followed by a definitive procedure to prevent it from happening again.
Acute Angle Closure: A True Emergency
An acute angle-closure attack causes a sudden, severe rise in eye pressure that can cause permanent vision loss within hours if untreated. Initial treatment focuses on rapidly lowering pressure using a combination of pressure-lowering eye drops (often several classes together), and sometimes an oral or intravenous medication (an oral carbonic anhydrase inhibitor or a hyperosmotic agent) to break the attack quickly. See our Eye Drops & Oral Medications page for detail on these medications.
Definitive Treatment: Laser Iridotomy
Once the attack is broken and the cornea is clear enough to allow a laser to be performed safely, laser peripheral iridotomy is performed to relieve the underlying pupillary block and prevent recurrence — typically in both the affected eye and, preventively, the unaffected fellow eye, which shares the same anatomic risk. See our Laser Peripheral Iridotomy page.
Laser Iridoplasty for Resistant Cases
In some patients, particularly those with a plateau iris configuration, the angle remains crowded even after a patent iridotomy. Laser peripheral iridoplasty, a related but distinct procedure that shrinks the peripheral iris tissue itself, can be used in these specific cases.
Lens Extraction
For patients with a cataract, or sometimes even a clear lens, removing the natural lens widens the angle directly and, per the EAGLE trial, can be a superior long-term option to laser iridotomy alone for angle-closure glaucoma with elevated pressure.1 See our Cataract Surgery for Glaucoma page.
Chronic Angle-Closure Glaucoma
Not all angle closure happens acutely — chronic angle closure develops gradually as the angle progressively scars closed (peripheral anterior synechiae) without ever causing a dramatic attack. Treatment still starts with addressing the angle anatomy (iridotomy, and lens extraction when appropriate), followed by standard open-angle-type medical or surgical treatment for any residual pressure elevation.
Learn more about angle-closure glaucoma itself, including its risk factors and how it's diagnosed, on our Narrow-Angle Glaucoma page.
References
- Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016;388(10052):1389-1397.
Frequently Asked Questions
What happens during an acute attack?
We use a combination of pressure-lowering eye drops, sometimes an oral or intravenous medication, to break the attack and bring pressure down quickly, before performing a definitive laser or surgical procedure once the eye has calmed down enough to do so safely.
Is this a medical emergency?
Yes. Acute angle closure can cause severe pain, nausea, and rapid, permanent vision loss if not treated promptly — if you have sudden eye pain, redness, blurred vision, halos, and headache or nausea, seek immediate care.
What happens after the attack is broken?
Laser peripheral iridotomy is typically performed once the cornea is clear enough, both in the affected eye and, preventively, in the unaffected fellow eye.
What if the angle stays partially closed after iridotomy?
This is called combined mechanism glaucoma, and additional treatment (drops, or occasionally MIGS or traditional surgery) is used for the residual open-angle-type component — see our Secondary Glaucoma Treatment page.
See a glaucoma specialist. Dr. Robert Gunzenhauser is Harvard-educated and UCLA fellowship-trained in glaucoma, providing expert diagnosis and treatment for Angle-Closure Glaucoma Treatment at Inland Glaucoma Center in Upland, CA.