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Glaucoma
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Narrow Angle Glaucoma

The "angle" refers to the physiological angle between the iris and the trabecular meshwork. When evaulating a patient for glaucoma, the physician examines this junction between the iris and the trabecular meshwork. An "open angle" means that the junction is wide enough to allow a normal flow of fluid through the trabecular meshwork. A "narrow angle" means that the junction is too narrow for fluid to flow normally, creating a risk of fluid backup which can cause increased eye pressure. As pressure rises, the iris may begin to bow forward, further restricting the flow of fluid and creating a shallow anterior chamber.

· Narrow Angle Glaucoma (NAG)
NAG accounts for approximately 5-10 percent of all glaucoma. It is more common in far-sighted people (hyperopes). Hyperopes tend to have physiologically smaller than average anterior chambers, which causes the iris tissue to bow forward. This iris bowing causes narrowing of the angle between the iris and the trabecular meshwork. The degree of narrowing determines the amount of pressure increase in the eye.

· Acute Narrow Angle Closure Glaucoma (ANAG)
ANAG is an emergency condition. Unlike POAG, in which the IOP increases slowly, pressure increases suddenly in ANAG patients. ANAG is the result of a complete closure of the angle between the trabecular meshwork and iris. Fluid blocked by the closure builds up rapidly, and pressure in the eye spikes dramatically. It is characterized by sudden onset of eye pain, halos and lights in vision, blurred vision, and is usually accompanied by nausea and vomiting. If the pressure is not relieved within a few hours, vision can be permanently lost in the affected eye, as damage to the optic nerve may occur quickly.

Treatment of Narrow Angle and Angle Closure Glaucoma

Medical treatment for Angle-Closure Glaucoma requires surgical intervention to reestablish a correct anatomical relationship between the iris and the trabecular meshwork.

· Peripheral Iridectomy

Laser iridectomy (also known as iridotomy) consists of reestabishing a correct anatomical relationship between the iris and drainage mechanism. A small hole is made in the iris, either with a laser iridectomy or surgical iridectomy. This hole allows for excess fluid to drain, relieving the buildup of pressure.

In emergency cases of acute angle closure, the patient will be given several medications to help lower the IOP while in the hospital or clinic. These medications may be given prior to, or during, the peripheral iridectomy procedure in an effort to reduce significantly high pressure as quickly as possible.

Peripheral iridectomy may be repeated if the desired IOP is not achieved after the initial procedure. Patients who undergo this procedure may experience an increased sensitivity to light, with mild glare noted with night driving. This is due to the increased amount of light entering the eye through the iridectomy opening.

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