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G
iampani
J
r
. J
et
al
.
192
R
ev
A
ssoc
M
ed
B
ras
2014; 60(3):192-195
guidelines in focus
Angle-closure glaucoma: diagnosis
G
laucoma
de
ângulo
fechado
:
diagnóstico
Authorship:
Brazilian Council of Ophthalmology
Final preparation:
September 19
th
, 2013
Participants:
Jair Giampani Jr, Ricardo Simões, Wanderley Marques Bernardo
http://dx.doi.org/10.1590/1806-9282.60.03.004The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in or-
der to standardize procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be
adopted, depending on the conditions and the clinical status of each patient.
D
escription
of
the
evidence
collection
method
:
The literature review of scientific articles in this guideline
was held in the databases Medline, Cochrane and SciELO.
The search for evidence came from actual clinical scenarios
and used keywords (MeSH terms) grouped in the following
syntax: (glaucoma, angle-closure or glaucoma, closed angle
or glaucomas, closed-angle or glaucoma, uncompensative
or glaucomas, uncompensative or angle closure glaucoma
or angle closure glaucomas or glaucomas, angle closure or
glaucoma, narrow-angle) and (gonioscopy or tomography
optical coherence or microscopy, acoustic or dark adapta-
tion). The articles were selected after critical evaluation of
the strength of scientific evidence, and publications of grea-
test strength were used for recommendation. The recom-
mendations were drawn from group discussion. The entire
guideline was reviewed by an independent group speciali-
zing in evidence-based clinical guidelines.
D
egree
of
recommendation
and
strength
of
evidence
:
A:
Experimental or observational studies of higher con-
sistency.
B:
Experimental or observational studies of lower con-
sistency.
C:
Case reports (non-controlled studies).
D:
Opinions without critical evaluation, based on con-
sensus, physiological studies, or animal models.
Objective:
To assess the main diagnostic methods used
in angle-closure glaucoma in the light of the best availa-
ble evidence.
Conflict of interest:
No conflict of interest informed.
I
ntroduction
Glaucoma is the generic name of an optic neuropathy
with multifactorial etiology characterized by progressive
damage to the optic nerve, with consequent impact on
the visual field. Even though it can present with intrao-
cular pressures considered within the normal range (nor-
mal tension glaucoma), elevation of intraocular pressu-
re (IOP) is the main risk factor. The most common type
is the primary open angle glaucoma, often asymptoma-
tic. Another type, called primary angle-closure glaucoma,
is characterized by occlusion of the anterior chamber an-
gle due to anatomic conditions that produce overlapping
or adhesion of the peripheral iris to the outer surface of
the camerular sinus, with consequent elevation of intrao-
cular pressure, damage to the optic disc and/or corres-
ponding visual field defect
1.2
(
D
). Acute primary angle clo-
sure (formerly called primary acute glaucoma) can cause
severe eye pain, headache, nausea, vomiting, elevated IOP
(often above 40 mm Hg) and reduced visual acuity, being
considered an ophthalmic emergency and requiring im-
mediate treatment
2
(
D
).
While glaucoma may or may not be accompanied by
various symptoms, an almost inevitable complication is
irreversible visual loss, affecting first the peripheral vi-
sion. Earlier loss is subtle and may go unnoticed by the
patient. In the late stages of the disease, moderate to se-
vere losses occur with impairment of central vision, so-
metimes progressing to blindness.
C
an
ultrasound
biomicroscopy
(
ubm
)
replace
gonioscopy
in
the
diagnosis
of
patients with
angle
-
closure
glaucoma
?
Gonioscopy consists in the biomicroscopic exam of the
topography of the anterior chamber angle (camerular si-