[Sportschosun Jang Jong-ho] If you are lying in a dark bedroom looking at your smartphone and suddenly feel a stabbing pain in your eyes, along with severe headaches, nausea, and vomiting, it may be more than a simple headache or digestive problem. It could be a warning sign of acute angle-closure glaucoma, an ophthalmic emergency that can threaten vision, so special caution is needed.
Acute angle-closure glaucoma is a condition in which the anterior chamber angle, the drainage pathway for aqueous humor inside the eye, suddenly becomes blocked, causing intraocular pressure to rise sharply. Within hours, pressure can climb above 40 to 60 mmHg, rapidly damaging the optic nerve and potentially leading to blindness.
The more familiar open-angle glaucoma is a disease in which the drainage channel remains open, but its function gradually declines, causing the visual field to narrow over time. By contrast, acute angle-closure glaucoma is characterized by a sudden blockage of the anterior chamber angle and the rapid onset of symptoms.
Angle-closure glaucoma accounts for about 15% to 20% of all glaucoma cases in South Korea, and acute attacks make up less than 2% to 5% of those cases, so it is not common. However, Asians are at relatively higher risk than Westerners because their eyes are often smaller and the anterior chamber is shallower. The number of patients has also been steadily rising as the population ages.
The golden time for treating acute angle-closure glaucoma is within 48 to 72 hours at most. But even a few hours of elevated eye pressure can cause irreversible damage to the optic nerve. In particular, the higher the pressure, the less effective medications such as eye drops become, making early treatment especially difficult. If treatment is delayed, permanent changes in eye structure and severe complications can occur, including pupillary paralysis caused by muscle dysfunction and pupillary synechiae, in which the iris sticks to surrounding tissue. The longer it is left untreated, the more likely it is to progress to chronic glaucoma and cause blindness, making prompt intervention critical.
Acute angle-closure glaucoma usually develops as people age, when the lens thickens and the iris is pushed forward, blocking the drainage pathway for aqueous humor. It is more likely to occur in people with naturally narrow anterior chamber angles or farsightedness, and an attack can be triggered when the pupil dilates in a dark place. Certain cold medicines, motion sickness drugs, and some diet pills can also cause the lens to move forward, so younger people should be careful as well.
High-risk groups include people in their 60s and 70s, women, farsighted patients, and those with a family history. If acute angle-closure glaucoma develops in one eye, the other eye is structurally similar and therefore at higher risk, so both eyes must be examined.
Typical symptoms include sudden, severe eye pain, vision loss, red eyes, and rainbow-colored halos around lights. These may also be accompanied by intense headaches, nausea, and vomiting. As a result, patients sometimes mistake the condition for a stroke, migraine, or digestive illness and first visit neurology or internal medicine, missing the treatment window.
The key to distinguishing it is the eye symptoms themselves. If one eye feels as if it is about to burst, along with a severe headache, blurred vision, and marked redness, immediate ophthalmic care is needed. In particular, if your vision becomes dim and your eyes feel heavy or sore in dark places or when you are tired, but then improve after sleep, it may be an intermittent angle-closure attack. This can be a warning sign of a major attack in which the anterior chamber angle becomes completely blocked, so an examination is necessary.
Diagnosis is made by measuring intraocular pressure to confirm elevated pressure, and by slit-lamp examination to observe a narrow angle, corneal edema, and pupil dilation. Gonioscopy or anterior segment optical coherence tomography is then used to confirm whether the aqueous humor drainage pathway is blocked.
The top treatment priority is to lower intraocular pressure quickly. After reducing the pressure with eye drops, oral medications, and hyperosmotic injections, laser iridotomy is performed once the corneal edema improves, creating a small opening in the iris so aqueous humor can flow. If pressure remains uncontrolled despite medication and laser treatment, or if the lens has thickened due to cataracts and angle closure is severe, cataract surgery, meaning lens extraction, may be the definitive treatment. If the closed-angle condition persists and becomes chronic, glaucoma surgery may also be needed. If the other eye is also at high risk, preventive laser iridotomy can reduce the chance of an acute attack.
Professor Kim Min-jin of the Department of Ophthalmology at Soonchunhyang University Bucheon Hospital said, "Acute angle-closure glaucoma is a frightening disease, but if it is detected early, it can be prevented and cured. Many patients miss the golden time because they do not realize it is an eye disease when they have headaches and vomiting," and added, "If you develop unexplained severe headaches, eye pain, blurred vision, or rainbow halos around lights, you should see an ophthalmologist immediately."
Jang Jong-ho, bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
