Primary Angle Closure

Primary angle closure
This leaflet explains more about how to recognise and treat primary angle closure
glaucoma. If you have any further questions, please speak to a doctor or practitioner
caring for you.
What is glaucoma?
Glaucoma is a term that describes a group of eye conditions that affect vision. When the eye is
functioning normally, fluid is produced inside the eye and is then drained away through the
drainage channel. The balance between the production and drainage of the fluid creates a
normal amount of pressure in the eye, which is needed for the eye to maintain its shape and
function. If the fluid cannot drain away properly, the pressure in the eye rises. If the pressure is
too high, the optic nerve at the back of the eye becomes damaged. The diagnosis of glaucoma
is given when there is evidence of optic nerve damage.
What is primary angle closure?

The most common type of glaucoma is called primary open angle glaucoma. This is when the
drainage channel (located between the iris and the cornea) is open. When the drainage channel
closes, the iris moves forwards and against the cornea, blocking the pathway to the drainage
channel and causing the pressure in the eye to rise. If this pressure remains high for a period of
time, the optic nerve can be damaged, which then leads to primary angle closure glaucoma.
There are a number of conditions that are closely related to primary angle closure:
Primary angle closure suspect This is when tests show that the drainage channel in your
eye is narrow and is at high risk of closing up at any time. This is more common in people with
smaller shaped eyes where the iris is naturally closer to the cornea.
Acute angle closure Primary angle closure is usually painless and occasionally causes
symptoms of mild headache. However, if the drainage channel suddenly closes and the
pressure suddenly becomes very high, the signs and symptoms are usually severe. This is
called acute angle closure.
What are the signs and symptoms of acute angle closure?

It is possible to experience an acute angle closure attack if you have been diagnosed with
primary angle closure suspect or if you have primary angle closure and are waiting for
treatment. It is therefore very important that you are aware of the signs and symptoms of an
angle closure attack.
Symptoms include:
intense pain of the eye
sore or tender eye area
headache
redness of the eye
blurred and reduced vision
seeing coloured haloes around lights.
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What should I do if I am experiencing any of these symptoms?

If you are experiencing any of these symptoms, you should seek medical advice as soon as
possible.
You can attend the eye casualty in the South Wing of St Thomas Hospital between 8.45am to
4.00pm, Monday to Friday. Outside of these hours, you should attend the St Thomas accident
and emergency (A&E) department.
If you do not live near St Thomas Hospital, you should attend a local hospital with an eye
casualty unit.
What treatment is available for primary angle closure?

The two main treatment options are laser peripheral iridotomy and cataract extraction
surgery.
Laser peripheral iridotomy
In this procedure, a laser beam is used to create a small hole in the iris. This provides another
route for the fluid to flow and pushes the iris backwards, in turn helping to open the drainage
channel. For more information on this procedure, please read the Having a laser peripheral
iridotomy information sheet. If you do not have a copy of this leaflet, please ask the nurse or
doctor caring for you.
Cataract surgery
When a cataract forms, the lens inside your eye slowly becomes thicker. This can push the iris
forwards, causing the drainage channel to become narrower. In a cataract operation, the natural
lens is removed and replaced by a thin artificial lens. This makes more room for the iris to move
backwards and allows the drainage channels to open. For more information on this procedure,
please ask for the Cataract surgery information leaflet.
Both procedures are effective in the treatment of primary angle closure. Your doctor will discuss
with you the treatment that is best for you.
You may be prescribed glaucoma medication in the form of drops and/or tablets, which should
be taken daily to control your eye pressures until the day of your procedure.
Your eye pressures may remain high even after the procedure. In these instances, drops may
be needed to lower the eye pressures forever.
What happens if I do not get treatment?

If the pressure in the eye remains high, extensive damage can occur to the optic nerve. This will
lead to significant and permanent visual loss.
Contact us
If you have any questions or concerns about your operation, please contact the eye casualty unit
on 020 7188 4316 (Monday to Friday, 8.45am 4pm).
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Useful sources of information

Pharmacy medicines helpline
For information about any medicines that you have been prescribed at Guy's and St Thomas'
hospitals, you can speak to the staff caring for you or call our helpline.
t: 020 7188 8748 9am to 5pm, Monday to Friday.
Patient Advice and Liaison Service (PALS) To make comments or raise concerns about
the Trusts services, please contact PALS. Ask a member of staff to direct you to the PALS
office or:
t: 020 7188 8801 at St Thomas t: 020 7188 8803 at Guys e: pals@gstt.nhs.uk
Knowledge & Information Centre (KIC) For more information about health conditions,
support groups and local services, or to search the internet and send emails, please visit the
KIC on the Ground Floor, North Wing, St Thomas Hospital.
t: 020 7188 3416
Language support services If you need an interpreter or information about your care in a
different language or format, please get in touch using the following contact details.
t: 020 7188 8815 fax: 020 7188 5953
NHS Direct - Offers health information and advice from specially trained nurses over the
phone 24 hours a day.
t: 0845 4647 w: www.nhsdirect.nhs.uk
NHS Choices Provides online information and guidance on all aspects of health and
healthcare, to help you make choices about your health.
w: www.nhs.uk
Become a member of your local hospitals, and help shape our future
Membership is free and it is completely up to you how much you get involved. To become a
member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth,
Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in
the last five years.
To join, please call 0848 143 4017, email members@gstt.nhs.uk or visit
www.guysandstthomas.nhs.uk
Leaflet number: 3601 / VER1

Date published: January 2013
Review date: January 2016
2012 Guys and St Thomas NHS Foundation Trust
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Primary Angle Closure

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Primary angle closure

What is primary angle closure?

What are the signs and symptoms of acute angle closure?

What should I do if I am experiencing any of these symptoms?

What treatment is available for primary angle closure?

What happens if I do not get treatment?

Useful sources of information

Leaflet number: 3601 / VER1

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