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Narrow Angle Glaucoma

Narrow-angle glaucoma is less common than open-angle glaucoma and the treatment is different. In narrow-angle glaucoma, the eye pressure goes up because the drainage of fluid inside the eye is blocked by contact between the iris and the eye’s internal drain, the trabecular meshwork.

The increase in eye pressure can be gradual or sudden. When it is gradual (chronic angle-closure glaucoma), there may be few if any symptoms. Vision is gradually lost as high eye pressures damage the nerve in the back of the eye.

When pressure elevation is sudden (acute angle-closure glaucoma), symptoms include severe eye pain, light sensitivity, blurred vision, seeing colored halos around lights, and nausea or vomiting. Acute angle-closure glaucoma is a sight-threatening emergency that requires prompt treatment.

Narrow-angle glaucoma is diagnosed using a procedure called gonioscopy to examine the internal drainage structures of the eyes.

Gonioscopy is used to examine the eye's internal drain

Treatment for narrow-angle glaucoma

The management of narrow-angle glaucoma begins with a procedure called peripheral laser iridotomy (link to iridotomy page). During this procedure, the surgeon uses a laser to place a small hole in the peripheral iris. This improves circulation of fluid inside the eye and helps restores the iris to its normal position away from the internal drain of the eye.

A small hole is visible in the iris

If the eye pressure remains too high after iridotomy, glaucoma medications might be necessary. Glaucoma medications usually come in the form of eye drops and work by either decreasing fluid production or increasing fluid drainage inside the eye. A variety of glaucoma medications are available. They each have their strengths and weaknesses. If treatment becomes necessary, your doctor will work with you to find a medication that works well and has the fewest number of side effects.

Glaucoma drops

Some of the available glaucoma medications

In some cases, the eye pressure remains elevated in spite of laser and medical treatment, and filtration surgery or glaucoma drainage implant surgery are indicated.

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