Hello and welcome to Case of the Day. I‘m Dr Croley and today we’re gonna discuss a case where a patient came in for a routine eye exam. And on the exam it was noted that their angles were narrow and that they’re susceptible to developing a True Angle Closure Glaucoma.
So what do we mean by Narrow Angles? So basically, narrow angle – the angle is this. So there’s an angle inside the eye where the iris comes out and then the cornea, the clear part goes up to this direction. So this angle between the iris or blue part or brown part of the eye inside the eye in the cornea, the clear part of the eye, that is the same blue here, either is open or narrow or closed.
And so when we’re talking about Glaucoma, in 90 or 70 percent of the cases, this angle is open. That is, the distance from the cornea to the iris is open and the fluid that is produced behind the pupil or iris is produced here, flows through the pupil, fills up the front of the eye and then drains this through the Trabecular Meshwork in the Schlemm’s Canal and out into the blood system. And so that is Open Angle Glaucoma; it’s when this angle’s open, it’s just the fluid’s having trouble getting into this meshwork.
In Narrow Angle, then now this iris now comes up close to the cornea and across, and this is basically just due to the size and shape of the eye. So people who are very farsighted, means that typically speaking, they have a small eye so their structure are closer together. And so that’s how we see our Narrow Angle Glaucoma typically and in people who are very farsighted because their eyes are small and this angle’s narrow.
So what happens? In Narrow Angle Glaucoma or true Angle Closure Glaucoma, is this fluid’s trying to go through the pupil and get over to the angle, the iris actually butts up to the cornea and blocks this meshwork a hundred percent so no fluid can get out of the eye. And so the pressure would suddenly rise and go up and instead of being a normal range of 10 to 21, the pressure would be 60 or 70. And so what happens when people have Acute Angle Closure Glaucoma, they have severe pain, nausea, vomiting, blurry vision, even very very blurry vision. They see halos around lights, and either pupils are dilated, their eyes are red.
And so this has happened years ago, many many years ago, when people went into the emergency room and they had a dilated pupil, they were in severe pain around their head. And way back before we had all the technology we have today, people had actually an operation to their brain because the neurosurgeon was concerned that they had an Aneurysm pressing on the nerve, blocking on the pupil and the pain was so severe they thought that that was an Aneurysm, so the pain can be very severe.
So this person today had a normal pressure, it’s just that this angle is very narrow and looked like it could close off in the near future. So what we did in this particular case, is we’ll schedule her to tomorrow for a Laser Iridotomy. So what we’re gonna do is laser an opening in the iris right here. And so now this is like a safety valve. So instead of the fluid have to make to track up here through the pupil and back and around, part of the fluid can go directly into this meshwork through the little opening that’s made so this keeps the angle from closing off on almost a hundred percent of cases. And so this is a preventative thing because when people have angle closure attacks, their pressure goes to 60 or 70, if not treated very quickly, can lose their vision, and it causes severe trauma or damage to the eye.
If you do come in, someone does come in with acute angle closure glaucoma, we have to try to get the pressure down because the cornea is now swollen so it’s hard to laser through the cornea sometimes because it’s swollen. And we give people hypertonic, a hyperosmotic solutions like Osmoglyn, which is a very syrupy sweet solution. Or actually a drug called Mannitol that we do IV that helps just pull fluid out that will acutely lower the eye pressure. Diamox, we give a lot of times. And then also eye drops and everything we can do to try to get the pressure down enough to actually put the laser opening. And once this laser opening is put in with someone who actually has an attack, their pressure immediately drops and goes back towards normal. It is almost like an instant cure. So if their angles are getting narrow, then it’s a wise thing to put this Iridotomy ahead of time because of all the severe complications related to having an Acute Angle Closure attack.
So if you have any questions about narrow angles or Acute Angle Closure Glaucoma, you can contact us through the website and we’ll be happy to try to answer those questions. If not, may God bless you with healthy eyes and great vision.