ICD-10: H40.2

Primary angle-closure glaucoma (PACG) is a significant ocular condition characterized by a sudden or gradual increase in intraocular pressure (IOP) due to the obstruction of the anterior chamber angle, which impedes the outflow of aqueous humor. This condition is classified under the ICD-10 code H40.2, which specifically pertains to primary angle-closure glaucoma.

Clinical Description

Definition

Primary angle-closure glaucoma occurs when the peripheral iris bows forward, obstructing the drainage angle formed by the cornea and the iris. This blockage can lead to a rapid increase in IOP, potentially resulting in optic nerve damage and vision loss if not treated promptly.

Symptoms

Patients with PACG may experience a range of symptoms, including:
- Sudden eye pain: Often severe and may be accompanied by headache.
- Nausea and vomiting: These systemic symptoms can occur due to the intense pain.
- Blurred vision: Patients may notice a sudden decrease in visual acuity.
- Halos around lights: This phenomenon occurs due to corneal edema.
- Redness of the eye: The affected eye may appear injected or red.

Risk Factors

Several factors increase the likelihood of developing PACG, including:
- Age: Older adults are at higher risk.
- Gender: Women are more frequently affected than men.
- Ethnicity: Certain populations, particularly those of Asian descent, have a higher prevalence.
- Family history: A genetic predisposition may play a role.

Diagnosis

Diagnosis of primary angle-closure glaucoma typically involves:
- Comprehensive eye examination: This includes measuring IOP, assessing the optic nerve, and evaluating the anterior chamber angle using gonioscopy.
- Visual field testing: To determine any loss of peripheral vision.
- Pachymetry: Measuring corneal thickness, which can influence IOP readings.

Treatment

Management of PACG focuses on lowering IOP and may include:
- Medications: Topical or systemic medications to reduce aqueous humor production or increase its outflow.
- Laser therapy: Procedures such as laser peripheral iridotomy or laser iridoplasty can create a new drainage pathway.
- Surgical intervention: In some cases, surgical options may be necessary to correct the anatomical issues causing the angle closure.

Conclusion

Primary angle-closure glaucoma is a serious condition that requires prompt diagnosis and treatment to prevent irreversible vision loss. Understanding the clinical features, risk factors, and management strategies is crucial for healthcare providers in effectively addressing this ocular emergency. The ICD-10 code H40.2 serves as a critical reference for coding and billing purposes in the context of this condition, ensuring accurate documentation and appropriate care delivery.

Primary angle-closure glaucoma (PACG), classified under ICD-10 code H40.2, is a significant ocular condition characterized by a sudden or gradual increase in intraocular pressure (IOP) due to the obstruction of the anterior chamber angle. This obstruction prevents the normal drainage of aqueous humor, leading to potential vision loss if not managed promptly. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with PACG is crucial for effective diagnosis and treatment.

Clinical Presentation

Symptoms

Patients with primary angle-closure glaucoma may experience a range of symptoms, which can vary in intensity:

• Acute Symptoms: In cases of acute angle-closure, patients often report sudden onset of severe eye pain, headache, nausea, and vomiting. They may also experience blurred vision and halos around lights due to corneal edema caused by elevated IOP[1][2].
• Chronic Symptoms: In chronic cases, symptoms may be less pronounced and can include intermittent episodes of blurred vision, eye discomfort, and difficulty focusing, which may be mistaken for other conditions[3].

Signs

Upon examination, several key signs may indicate the presence of PACG:

• Elevated Intraocular Pressure: IOP is typically significantly elevated, often exceeding 30 mmHg during acute episodes[4].
• Corneal Edema: The cornea may appear cloudy due to fluid accumulation, which can occur rapidly in acute cases[5].
• Mid-Dilated Pupil: The affected eye may exhibit a mid-dilated, non-reactive pupil, indicating a failure of the iris to respond to light[6].
• Shallow Anterior Chamber: A shallow anterior chamber can be observed during slit-lamp examination, which is a hallmark of angle-closure[7].

Patient Characteristics

Demographics

Certain demographic factors are associated with a higher risk of developing PACG:

• Age: PACG is more prevalent in older adults, particularly those over the age of 60, as the anatomical changes in the eye become more pronounced with age[8].
• Gender: Women are at a higher risk than men, likely due to anatomical differences in the eye and hormonal factors[9].
• Ethnicity: Certain ethnic groups, particularly those of Asian descent, have a higher incidence of PACG, which may be attributed to anatomical variations in the anterior chamber angle[10].

Risk Factors

Several risk factors can predispose individuals to PACG:

• Family History: A family history of glaucoma can increase the likelihood of developing PACG[11].
• Hyperopia: Individuals with hyperopia (farsightedness) are at greater risk due to the smaller anterior chamber depth associated with this refractive error[12].
• Previous Eye Surgery: History of cataract surgery or other ocular procedures can alter the anatomy of the eye and increase the risk of angle-closure[13].

Conclusion

Primary angle-closure glaucoma is a serious condition that requires prompt recognition and management to prevent irreversible vision loss. The clinical presentation often includes acute symptoms such as severe eye pain and nausea, alongside significant signs like elevated IOP and corneal edema. Patient characteristics, including age, gender, ethnicity, and specific risk factors, play a crucial role in identifying those at risk. Early diagnosis and intervention are essential for preserving vision and improving patient outcomes in those affected by PACG.

Primary angle-closure glaucoma (PACG) is a specific type of glaucoma characterized by a sudden increase in intraocular pressure due to the blockage of the drainage angle in the eye. The ICD-10 code for this condition is H40.2, which encompasses various aspects of PACG. Below are alternative names and related terms associated with this condition.

Alternative Names for Primary Angle-Closure Glaucoma

1. Acute Angle-Closure Glaucoma: This term is often used to describe a sudden onset of symptoms, including severe eye pain, headache, nausea, and vomiting, which can occur when the drainage angle becomes completely blocked.

2. Chronic Angle-Closure Glaucoma: This refers to a more gradual onset of angle closure, which may not present with acute symptoms but can still lead to significant vision loss over time.

3. Narrow-Angle Glaucoma: This term describes the anatomical configuration of the eye where the angle between the iris and cornea is narrower than normal, predisposing individuals to angle-closure episodes.

4. Closed-Angle Glaucoma: Similar to narrow-angle glaucoma, this term emphasizes the closure of the drainage angle, which can lead to increased intraocular pressure.

5. Secondary Angle-Closure Glaucoma: While not the same as primary angle-closure glaucoma, this term refers to angle closure that occurs as a result of other conditions, such as inflammation or tumors.

Related Terms

1. Intraocular Pressure (IOP): A critical measurement in glaucoma management, as elevated IOP is a primary risk factor for optic nerve damage.

2. Visual Field Loss: A common consequence of untreated angle-closure glaucoma, where peripheral vision is affected.

3. Pupil Block: A mechanism that can lead to angle closure, where the iris obstructs the flow of aqueous humor, causing pressure to build up.

4. Gonioscopy: A diagnostic procedure used to examine the drainage angle of the eye, crucial for diagnosing angle-closure glaucoma.

5. Laser Peripheral Iridotomy (LPI): A common treatment for angle-closure glaucoma, where a laser is used to create a small hole in the peripheral iris to improve fluid drainage.

6. Aqueous Humor: The fluid produced in the eye that maintains intraocular pressure and provides nutrients to the eye structures.

Understanding these alternative names and related terms can help in better recognizing and discussing primary angle-closure glaucoma, its implications, and management strategies. If you have further questions or need more detailed information on any specific aspect, feel free to ask!

Primary angle-closure glaucoma (PACG), classified under ICD-10 code H40.2, is a serious condition characterized by a sudden increase in intraocular pressure due to the closure of the anterior chamber angle. This condition can lead to significant vision loss if not managed promptly. The treatment approaches for PACG are multifaceted, focusing on both immediate relief of intraocular pressure and long-term management to prevent recurrence.

Immediate Management

1. Medications

The first line of treatment for acute angle-closure glaucoma typically involves pharmacological interventions aimed at lowering intraocular pressure (IOP). Commonly used medications include:

• Carbonic Anhydrase Inhibitors: Such as acetazolamide, which reduces aqueous humor production.
• Topical Beta-Blockers: Like timolol, which decrease aqueous humor production.
• Alpha Agonists: Such as apraclonidine, which also reduce aqueous humor production and increase uveoscleral outflow.
• Prostaglandin Analogues: These can enhance outflow of aqueous humor.
• Mannitol: An osmotic agent administered intravenously to rapidly decrease IOP by drawing fluid out of the eye.

2. Laser Therapy

In cases of acute PACG, laser therapy is often employed to create a new drainage pathway for aqueous humor:

• Laser Peripheral Iridotomy (LPI): This procedure involves creating a small hole in the peripheral iris to allow fluid to bypass the blocked angle, effectively lowering IOP and preventing future attacks.

Long-term Management

1. Surgical Options

For patients with chronic PACG or those who do not respond adequately to medical therapy, surgical interventions may be necessary:

• Goniotomy: This procedure involves surgically opening the angle to improve aqueous outflow.
• Trabeculectomy: A more invasive procedure that creates a new drainage pathway for aqueous humor, reducing IOP.

2. Ongoing Monitoring and Treatment

Patients diagnosed with PACG require regular follow-up to monitor IOP and assess the effectiveness of treatment. Long-term management may include:

• Continued Use of Medications: Patients may need to remain on topical medications to control IOP.
• Lifestyle Modifications: Recommendations may include avoiding certain medications that can precipitate angle closure, such as anticholinergics and some antidepressants.

Conclusion

The management of primary angle-closure glaucoma is critical to preserving vision and preventing complications. Immediate treatment focuses on lowering intraocular pressure through medications and laser therapy, while long-term strategies may involve surgical options and ongoing monitoring. Regular follow-up is essential to ensure effective management and to adapt treatment plans as necessary. Early intervention and comprehensive care are key to improving outcomes for patients with PACG.

Primary angle-closure glaucoma (PACG) is a serious eye condition that can lead to vision loss if not diagnosed and treated promptly. The diagnosis of PACG is guided by specific criteria, which are essential for accurate coding under the ICD-10-CM code H40.2. Below, we explore the diagnostic criteria and considerations for this condition.

Diagnostic Criteria for Primary Angle-Closure Glaucoma (ICD-10 Code H40.2)

1. Clinical Symptoms

• Acute Symptoms: Patients may present with sudden onset of symptoms such as severe eye pain, headache, nausea, vomiting, and blurred vision. These symptoms are often indicative of an acute attack of angle-closure glaucoma.
• Chronic Symptoms: In chronic cases, symptoms may be less pronounced but can include intermittent blurring of vision and halos around lights.

2. Intraocular Pressure (IOP) Measurement

• Elevated intraocular pressure is a hallmark of glaucoma. For PACG, IOP is typically significantly higher than normal (greater than 21 mmHg), especially during acute episodes. Measurement should be performed using tonometry.

3. Gonioscopy

• Gonioscopy is a critical diagnostic tool that allows the clinician to visualize the anterior chamber angle. In PACG, the angle is typically closed or very narrow, which can be confirmed through this examination. The presence of peripheral anterior synechiae (PAS) may also be noted.

4. Optic Nerve Assessment

• Evaluation of the optic nerve head is essential. Signs of glaucomatous damage, such as cupping or pallor of the optic disc, may be observed. This assessment can be performed through direct ophthalmoscopy or imaging techniques.

5. Visual Field Testing

• Visual field tests may reveal characteristic defects associated with glaucoma, such as peripheral vision loss. These tests help in assessing the functional impact of the disease.

6. Patient History

• A thorough patient history is important, including any previous episodes of eye pain or visual disturbances, family history of glaucoma, and any other risk factors such as age, gender, and ethnicity.

7. Exclusion of Other Conditions

• It is crucial to rule out other types of glaucoma or ocular conditions that may mimic PACG. This includes evaluating for secondary causes of angle closure, such as tumors or inflammation.

Conclusion

The diagnosis of primary angle-closure glaucoma (ICD-10 code H40.2) involves a comprehensive evaluation that includes clinical symptoms, intraocular pressure measurement, gonioscopy, optic nerve assessment, visual field testing, and patient history. Accurate diagnosis is vital for timely intervention to prevent vision loss. Clinicians must be vigilant in recognizing the signs and symptoms of PACG, especially in at-risk populations, to ensure effective management and treatment.