Sub-acute attacks of Glaucoma

[Retired_Electronics_Engineer]

Hopefully you are aware of this but angle closure glaucoma in all its variants acute, chronic, intermittent tends to run in families (and of course occurs almost exclusively in hyperopic/farsighted people). So it is critical that all your blood relatives know about your acute glaucoma problem and have their own eyes checked regularly especially after age 40 by an Eye MD ophthalmologist whom they have told about your problem.

Their also is a higher incidence of OPEN angle glaucoma in eyes that have had LPI and/or acute/chronic/recurrent angle closure glaucoma

JCH MD
JohnHaganMD | 7 hours

Thanks for that.
Yes, I am very well aware of glaucoma running in families.
The only reason I became aware of my first attack or sub acute of raised inter-ocular pressure was when I was aged 38.

I was driving home at night after a strenuous game of squash and became aware of concentric ring halos from the headlamps of oncoming cars.(only in the left eye) I immediately knew something was wrong. My Father had had very similar experiences in his fifties .So I was on to the case very early and saw a glaucoma specialist within two days and shortly after periferal irodectomies were performed in both eyes.

My understanding is that acute attacks of glaucoma are due to the sudden high pressure increase in the anterior chamber. This causes a temporary absorption of the aqueous humour into the inside of the cornea causing it to become temporarily slightly opaque. After a few hours rest the problem goes away and the patient thinks there is nothing to worry about. In my experience this is the time to seek urgent expert advice!


In those days the operation was carried out surgically with a kind of hooked scalpel and involved staying in hospital for about 5 days. Today it's a quick procedure with laser and home.
It's amazing how technology has transformed eye care in the last 30 years or so.
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In my Father's case he took pilocarpine in both eyes for quite a long time before having irodectomies in both eyes. He then received very bad advice from the surgeon who said he was cured and didn't require further checkups. This was the worst possible advice because he subsequently developed chronic glaucoma as well and lost periferal vision before the problem was detected. He subsequently had a trabeculectomy in one of his eyes in his late seventies and an IOL was fitted in that eye he also ended up with the iris sticking to the lens capsule and the iris was very badly torn in the operation.(maybe Pilocarpine was slightly to blame)
All in all a very sad state of affairs for my poor old Dad. When he died age 84 his eyesight was in a very bad way with tunnel vision and very bad acuity.

I suppose I am the lucky one here, that's why I have developed a great interest in eye care and strive hard not to fall into the scenario of my Father.

I will continue to stress the importance of regular eye check ups to my two son's and their families.

[JohnHaganMD]

The mechanism of angle closure glaucoma is due to the shape of the eye and what is called pupillary block.  Fluid called aqueous comes into the front part of the eye (anterior chamber) being produced by the ciliary behind the iris, it flows through the pupil and exits at the base of the iris in the "filtration angle". In the farsighted eye the eye is short and this space is narrow (think garage door size one door vs 2 door vs 3 door   1 door= hyperopia  2 door= normal 3 door = myopia).  In pupillary block the base of the iris bows back and blocks the flow of fluid out of the eye like putting a drain plug in a sink.  As the pressure goes up the pupil stops working and the cornea cells that pump fluid out of the cornea also stop so the cornea swells and turns cloudy (cornea edema). If the attack breaks due to good luck then the problem can reoccur (intermittent)  it may stay blocked but the pressure can go up so slowly the symptoms are very mild and the diagnosis may be missed (chronic angle closure).  Treatment involves using a laser to make a hole in the iris for the aqueous to get into the anterior chamber near the base of the iris. Pilocarpine works by making the pupil small and pulling folds of iris out of the filtration angle (like closing a side curtain on a window)  Your family is at high risk with 2 generations so get the word out not only to your children but your nieces and nephews.