Narrow angle glaucoma (or angle closure glaucoma) is a special type of glaucoma, commonly seen in patients who are far-sighted. Patients with far-sighted eyes tend to have shorter eyes (front-to-back), and so the space inside the eye is physically smaller. As the natural lens inside the eye grows in size, it begins to crowd out the other structures within this smaller eye. One of these structures is the anterior chamber angle.
This anterior chamber angle of the eye is equivalent to the drain of a sink. When this structure is crowded, the liquid nutrients within the eye cannot drain away as easily, leading to a potential build-up of eye pressure. When the pressure is high enough to cause optic nerve damage (the optic nerve connects the eye to the brain), it is called narrow angle glaucoma or angle closure glaucoma.
More commonly, patients have angles which are at high risk for angle closure, but the optic nerve has not yet been damaged. This condition is referred to as anatomically narrow angles.
The initial treatment for narrow angle glaucoma or anatomical narrow angles is the same. The anterior chamber angle needs to be opened. This is commonly done by a procedure called a YAG laser peripheral iridotomy (YAG PI). This laser is used to create a small opening in the iris (the colored part of the eye). The opening allows the structures within the eye to shift. If enough shifting occurs, the anterior chamber angle can open up, effectively resolving the blockage.
If the YAG PI is not performed in a timely fashion, the anterior chamber angle could close completely, resulting in acute angle closure glaucoma. In essence, the drain is completely closed and no fluid can exit the eye. If this happens, the pressure in the eye rises rapidly, which can then lead to significant damage to the eye and even loss of vision. Typical symptoms a patient might have as the pressure rises include blurry vision, pain, and nausea or vomiting. Acute angle closure glaucoma is considered a true eye emergency, and needs to be treated quickly.
A YAG laser peripheral iridotomy is a well-tolerated procedure and only requires eye drops for anesthesia. After the procedure, steroid eye drops are used for about a week to prevent the newly created opening in the iris from closing up. It is a relatively safe procedure that could prevent angle closure and the potential devastating consequences associated with it.
Here at the San Jose Eye Institute, Dr. Decker and Dr. Yang treat all types of glaucoma, including narrow angle glaucoma and anatomically narrow angles. If you have questions, please feel free to come in and visit us to learn more.