Question

Enumerate signs of primary angle closure glaucoma in iris, angle of anterior chamber, crystalline lens and optic nerve head.

Hint:

The key signs of primary angle closure glaucoma include a fixed, mid-dilated pupil, a narrow or closed anterior chamber angle, and optic nerve head damage. Early diagnosis is essential to prevent vision loss.

Answer 1

Step 1: Signs of Primary Angle Closure Glaucoma.
Primary angle closure glaucoma (PACG) is characterized by several key signs in different parts of the eye. These signs help in diagnosing and assessing the severity of the condition:
(1) Iris: - Mid-dilated Pupil: The pupil is often fixed and mid-dilated, which is a hallmark of angle closure. This occurs due to the blockage of the aqueous humor outflow, which leads to reduced pupil reactivity.
- Iris Ischemia: Prolonged elevated IOP can cause ischemia in the iris, which may lead to atrophy or thinning of the iris tissue.
(2) Angle of Anterior Chamber: - Narrow or Closed Angle: The hallmark of PACG is the narrowing or closure of the angle between the iris and the cornea, which is assessed by gonioscopy. This leads to impaired aqueous humor drainage and increased IOP.
- Gonioscopy Findings: The angle may appear narrow or completely closed, with the trabecular meshwork hidden behind the peripheral iris.
(3) Crystalline Lens: - Lens Opacities (Cataracts): Chronic elevation of IOP can lead to the formation of cataracts, as the elevated pressure interferes with the normal metabolism of the lens.
- Lens Enlargement: In some cases, the lens may become displaced or enlarged, contributing to further closure of the anterior chamber angle.
(4) Optic Nerve Head: - Optic Disc Cupping: Elevated IOP can lead to optic nerve head damage, which is seen as an increase in the cup-to-disc ratio (optic disc cupping). This is a sign of glaucomatous optic neuropathy.
- Optic Nerve Pallor: Chronic optic nerve damage due to high IOP can lead to pallor or atrophy of the optic nerve head.
- Visual Field Loss: In severe cases, damage to the optic nerve can lead to peripheral visual field loss and eventually blindness if not treated promptly.