The difference between open-angle and closed-angle glaucoma

Written by Peng Xi Feng
Ophthalmology
Updated on September 18, 2024
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Primary angle-closure glaucoma is a type of glaucoma caused by the peripheral iris blocking the trabecular meshwork, or permanently adhering to the trabecular meshwork, obstructing the outflow of aqueous humor, leading to increased intraocular pressure. It is characterized by a narrow angle and the anatomical feature of the peripheral iris being prone to contact with the trabecular meshwork. Gonioscopy confirming angle closure is an important diagnostic criterion. The characteristic of open-angle glaucoma, however, is that even though intraocular pressure is elevated, the angle remains open, with the obstruction of aqueous outflow occurring at the trabecular meshwork system.

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Written by Peng Xi Feng
Ophthalmology
54sec home-news-image

What are the symptoms of a glaucoma attack?

Typical acute angle-closure glaucoma has several different clinical stages, divided into the preclinical stage, prodromal stage, acute attack stage, intermittent stage, chronic stage, and absolute stage. The acute attack stage is mainly characterized by severe headache, eye pain, photophobia, tearing, and significant deterioration of vision, often reduced to counting fingers or hand motion, and may be accompanied by systemic symptoms such as nausea and vomiting. Physical signs include eyelid edema, mixed congestion, corneal epithelial edema, and the appearance of small droplets under the slit lamp. Patients may complain of rainbow vision, which primarily occurs due to the large number of small vesicles in the swollen corneal epithelium and the spaces between epithelial cells.

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Written by Wang Hui Zhen
Ophthalmology
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Early symptoms of glaucoma

There are many types of glaucoma, and the symptoms vary between different types. Some patients with glaucoma might not have noticeable symptoms in the early stages; others may only experience mild eye soreness and occasional blurred vision, which can improve with rest; some present with insidious vision decline and field defects. Glaucoma refers to a group of progressive optic nerve damage that eventually impairs vision, mainly associated with pathological elevation of intraocular pressure. Glaucoma is the second leading cause of blindness worldwide, and it is the top irreversible blinding eye disease. Common symptoms of glaucoma include blurry vision, vision decline, field defects, and acute attacks, often accompanied by eye pain, headache, nausea, vomiting, and more. If glaucoma symptoms occur, or there is a suspicion of glaucoma, it is advised to visit an ophthalmology clinic for comprehensive examinations like visual acuity, intraocular pressure, fundus examinations, etc., to determine the cause and provide targeted treatment, actively reduce intraocular pressure, and protect the optic nerve.

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Written by Li Zhen Dong
Ophthalmology
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How to rule out glaucoma with high eye pressure?

Normal intraocular pressure ranges from 10-21mmHg. If it exceeds 21mmHg, it is considered to be increased intraocular pressure. Main symptoms of high intraocular pressure include eye distension, eye pain, tearing, photophobia, blurred vision, nausea, vomiting, headache, etc. High intraocular pressure is a primary diagnostic criterion for glaucoma, but it is not the only standard. Glaucoma can be divided into primary glaucoma, secondary glaucoma, congenital glaucoma, and mixed glaucoma. Primary glaucoma can further be subdivided into open-angle glaucoma and angle-closure glaucoma. Only during an acute attack of angle-closure glaucoma does the intraocular pressure increase, whereas open-angle glaucoma generally does not affect intraocular pressure. Therefore, the diagnosis of glaucoma mainly relies on a comprehensive assessment of the angle of the anterior chamber, intraocular pressure, visual field, visual acuity, and the condition of the optic disc.

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Written by Zheng Xin
Ophthalmology
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Is high intraocular pressure always glaucoma?

Glaucoma is a group of eye diseases characterized by typical optic nerve atrophy and visual field defects, with high intraocular pressure and visual field loss as features. Clinically, some patients have long-term high intraocular pressure but do not exhibit optic nerve and visual field damage. This condition is not called glaucoma, but is referred to as ocular hypertension. Meanwhile, some patients may have normal eye pressure but still exhibit typical glaucoma optic nerve damage and visual field defects; this condition is called normal-tension glaucoma. Therefore, high intraocular pressure does not necessarily indicate glaucoma, and normal intraocular pressure can also potentially be glaucoma.

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Written by Li Zhen Dong
Ophthalmology
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Is vitreous opacity a precursor to glaucoma?

Vitreous opacities are not a precursor to glaucoma. Vitreous opacities can be divided into physiological and pathological types. Physiological vitreous opacities generally do not affect vision, and one may see variously shaped black shadows in front of the eyes. Pathological vitreous opacities can impact vision and should be further examined by an ophthalmologist. The precursors of glaucoma include eye pressure, eye pain, photophobia, tearing, relief after rest, and a decrease in vision, along with halos seen around lights. If these symptoms occur, active treatment should be sought. Glaucoma can be classified into primary, secondary, congenital, and mixed types.