Closed Angle Glaucoma by Denise Allen

By at October 30, 2011 | 1:56 pm | Print

Would you be able to tell the difference between a migraine head ache and something more serious?  My  sister could not and it almost cost her sight.  She, along with about  30 million people suffer from migraines. The pain from a migraine is usually felt around the eyes and temple area.  Migraines can  include vision disturbances.  She had recently started taking the drug Tobomax for control of the symptoms. ” The American Migraine Prevalence and Prevention Study showed that almost 98 percent of people with frequent migraines take medications.”1  She had normal warning signs that a headache was coming, halos around lights, eye pain, slightly blurred vision.  But she stated that she didn’t feel nauseated and noises didn’t seem to bother her, she attributed this to the new medicine.

What my sister thought was a migraine headache was one of the more serious, but less common, forms of glaucoma.  Angle-closure glaucoma, also known as, closed angle glaucoma. Closed angle glaucoma develops quickly and has symptoms that are very similar to symptoms of a migraine. Severe eye pain, nausea, vomiting, blurred vision and halos around lights.  This type of glaucoma can happens when the pupil dilates.  As a result,” the peripheral edge of the iris can become bunched against its corneal attachment.  This causes drainage angle to close. Angle closure can occur in two ways: the iris may be pushed forward up against the trabecular  mesh or the iris may be pulled up against the trabecular  mesh. In either case, the position of the iris causes the normally open anterior chamber angle to close.  When this happens the aqueous humor fluid is prevented from draining and the pressure inside the eye quickly rises.”2

In the United States, fewer than 10% of glaucoma cases are due to angle-closure glaucoma.  Yet in Asia, angle-closure glaucoma is a common form of glaucoma and much more common than open-angle glaucoma.4  You can have a predisposition to closed angle glaucoma by inheritance, if you have  smaller or almond shape eyes.  Also if you are farsighted and by age, as we age the shape of our eyes changes, the lens of  the eye enlarges and pushes the iris forward.  The most common causes of closed angle glaucoma are trauma, and medication. “Trauma that could have happened as a child playing sports, or blunt trauma where the injury doesn’t even penetrate the eye. With both forms of injury, closed angle glaucoma could happen immediately or years later”.

Medications can also increase the chance of this type of glaucoma. “These medications include patches used to prevent seasickness, antihistamines, Claritin, antidepressants, citalopram (Celexa), and anticonvulsant, topiramate (Topamax), also used to treat migraines in adults.”3

As we were talking I noticed that she kept blinking.  When I questioned her she stated that although she was getting a headache  she had been working with bleach the day before in closed space, and her eyes were blurry, but that they seemed much worse and her eyes felt heavier than a normal headache.   I insisted her that she should call her doctor.  Although she was in pain and nauseated she chose to wait until Monday. Stating at least she wasn’t throwing up and as soon as she did she’d feel better.  On Monday, she went to see her ophthalmologist.  He sent her immediately to a specialist. He asked her what medications she was taking and if she ever had a head injury.  He told her that the medication she was taking could cause increased eye pressure. It could also cause permanent loss of vision if not treated.  Her doctor preformed laser surgery within the hour. The name for this type of surgery is called an Iridotomy.  With the use of a laser, a beam creates an opening in the iris so the aqueous humor fluid, which is trapped in the posterior chamber, can reach the anterior chamber and the drainage channels. As the fluid flows into the anterior chamber through this opening in the iris, the pressure behind the iris  decreases, allowing the iris to return to its normal position. This procedure opens the angle of the anterior chamber and relieves the blockage at the trabecular mesh work.4 This is the most commonly used procedure for treating closed angle glaucoma.

Closed angle glaucoma and open- angle glaucoma are an eye disease where the optic nerve is damage.  Dr Doreen Fazio of the Jules Stein Eye Institute of UCLA  wrote “Glaucoma is the second leading cause of blindness in the world.  It is recommended that you have a dilated eye exam every two years. With early diagnosis there are treatments that can often protect against irreversible damage to the optic nerve that can lead to serious vision loss. Glaucoma can be treated with eye medications, lasers, and various surgical procedures. However, if glaucoma is not controlled it can cause debilitating loss of vision.”

Globally, 60.5 million had glaucoma in 2010. Given the aging of the world’s population, this number may increase to almost 80 million by 2020.
Glaucoma costs the U.S. economy $2.86 billion every year in direct costs and productivity losses.

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