ICD-10: H40.21

Acute angle-closure glaucoma is a serious and urgent condition that requires immediate medical attention. Below is a detailed clinical description and relevant information regarding the ICD-10 code H40.21, which specifically pertains to this condition.

Clinical Description of Acute Angle-Closure Glaucoma

Definition

Acute angle-closure glaucoma (AACG) is characterized by a sudden increase in intraocular pressure (IOP) due to the obstruction of the aqueous humor outflow. This obstruction occurs when the peripheral iris is pushed or pulled forward, blocking the trabecular meshwork, which is responsible for draining fluid from the eye. This condition can lead to rapid vision loss if not treated promptly.

Symptoms

Patients with acute angle-closure glaucoma typically present with a range of symptoms, including:
- Severe eye pain: Often described as a deep, aching pain.
- Headache: Frequently associated with the eye pain.
- Nausea and vomiting: These symptoms can occur due to the intense pain and increased pressure.
- Blurred vision: Patients may experience sudden changes in vision.
- Halos around lights: This phenomenon occurs due to corneal edema.
- Redness of the eye: The affected eye may appear red and inflamed.

Risk Factors

Several factors can increase the risk of developing acute angle-closure glaucoma, including:
- Age: More common in older adults.
- Gender: Women are at a higher risk than men.
- Ethnicity: Higher prevalence in individuals of Asian descent.
- Family history: A genetic predisposition may increase risk.
- Pre-existing eye conditions: Such as hyperopia (farsightedness) or a history of cataract surgery.

Diagnosis

Diagnosis of acute angle-closure glaucoma is typically made through:
- Clinical examination: Including assessment of IOP, which is often significantly elevated (greater than 30 mmHg).
- Gonioscopy: This procedure allows the clinician to visualize the angle of the anterior chamber and confirm the presence of angle closure.
- Visual field testing: To assess any loss of peripheral vision.

Treatment

Immediate treatment is crucial to prevent permanent vision loss. Management strategies include:
- Medications: To lower IOP, such as carbonic anhydrase inhibitors, beta-blockers, and prostaglandin analogs.
- Pilocarpine: A miotic agent that helps to open the angle.
- Laser therapy: Laser peripheral iridotomy is often performed to create a new drainage pathway for aqueous humor.
- Surgical intervention: In some cases, surgical options may be necessary to prevent recurrence.

ICD-10 Code H40.21

The ICD-10-CM code H40.21 specifically designates acute angle-closure glaucoma. This code is part of the broader category of glaucoma codes (H40) and is essential for accurate medical billing and coding, ensuring that healthcare providers can effectively document and manage this urgent condition.

Importance of Accurate Coding

Accurate coding is vital for:
- Insurance reimbursement: Ensuring that healthcare providers are compensated for the services rendered.
- Epidemiological tracking: Assisting in the collection of data for public health monitoring and research.
- Clinical management: Facilitating appropriate treatment plans based on the specific diagnosis.

In summary, acute angle-closure glaucoma (ICD-10 code H40.21) is a critical ocular emergency that necessitates prompt recognition and intervention to prevent irreversible damage to vision. Understanding its clinical presentation, risk factors, and treatment options is essential for healthcare professionals involved in eye care.

Acute angle-closure glaucoma (AACG) is a medical emergency characterized by a sudden increase in intraocular pressure due to the closure of the anterior chamber angle, which obstructs the outflow of aqueous humor. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management.

Clinical Presentation

Symptoms

Patients with acute angle-closure glaucoma typically present with a combination of the following symptoms:

• Severe Eye Pain: This is often described as a deep, aching pain that can be debilitating.
• Headache: Patients may experience a headache, which can be localized to the affected eye or diffuse.
• Nausea and Vomiting: Due to the intense pain and increased intraocular pressure, patients may also experience gastrointestinal symptoms.
• Blurred Vision: Vision may become hazy or blurred, often accompanied by halos around lights.
• Red Eye: The affected eye may appear red due to conjunctival injection.

Signs

Upon examination, healthcare providers may observe several key signs indicative of acute angle-closure glaucoma:

• Elevated Intraocular Pressure (IOP): IOP is typically significantly elevated, often exceeding 30 mmHg.
• Mid-Dilated Pupil: The pupil may be non-reactive or poorly reactive to light, often appearing mid-dilated.
• Corneal Edema: The cornea may appear cloudy or edematous due to increased pressure.
• Shallow Anterior Chamber: A shallow anterior chamber can be noted during slit-lamp examination, indicating angle closure.
• Ciliary Injection: There may be a circumlimbal flush, indicating inflammation.

Patient Characteristics

Demographics

Certain demographic factors are associated with a higher risk of developing acute angle-closure glaucoma:

• Age: AACG is more common in older adults, particularly those over 60 years of age.
• Gender: Women are at a higher risk than men, likely due to anatomical differences in the eye.
• Ethnicity: Individuals of Asian descent are more prone to angle-closure glaucoma due to anatomical predispositions.

Anatomical Considerations

Patients with specific anatomical features may be more susceptible to AACG:

• Shallow Anterior Chamber: Individuals with a naturally shallow anterior chamber are at increased risk.
• Hyperopia (Farsightedness): Those with hyperopia may have a more pronounced risk due to the shape of the eye.
• Family History: A family history of glaucoma can increase the likelihood of developing AACG.

Comorbid Conditions

Certain medical conditions may also contribute to the risk of acute angle-closure glaucoma:

• Diabetes: Patients with diabetes may have a higher incidence of glaucoma.
• Other Eye Conditions: Conditions such as cataracts or previous eye surgeries can predispose individuals to AACG.

Conclusion

Acute angle-closure glaucoma is a serious condition that requires immediate medical attention. Recognizing the clinical presentation, including the hallmark symptoms of severe eye pain, headache, nausea, and visual disturbances, along with specific signs such as elevated intraocular pressure and mid-dilated pupils, is essential for timely intervention. Understanding patient characteristics, including age, gender, ethnicity, and anatomical predispositions, can aid in identifying at-risk individuals and facilitating early diagnosis and treatment. Prompt management is critical to prevent permanent vision loss associated with this condition.

Acute angle-closure glaucoma, represented by the ICD-10 code H40.21, 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. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Here’s a detailed overview:

Alternative Names for Acute Angle-Closure Glaucoma

1. Acute Glaucoma: This term is often used interchangeably with acute angle-closure glaucoma, emphasizing the sudden onset of symptoms.
2. Angle-Closure Glaucoma: A broader term that includes both acute and chronic forms, but often refers to the acute variant in clinical settings.
3. Closed-Angle Glaucoma: This term highlights the anatomical aspect of the condition, where the angle between the iris and cornea is closed or blocked.
4. Narrow-Angle Glaucoma: While this term can refer to a predisposition to angle-closure, it is sometimes used to describe acute episodes as well.

Related Terms

1. Primary Angle-Closure Glaucoma: This term refers to angle-closure glaucoma that occurs without any underlying eye disease. It is often used in contrast to secondary angle-closure glaucoma, which is caused by other conditions.
2. Secondary Angle-Closure Glaucoma: This refers to angle-closure that results from other ocular or systemic conditions, such as tumors or inflammation.
3. Intraocular Pressure (IOP): A critical measurement in diagnosing and managing glaucoma, including acute angle-closure glaucoma.
4. Visual Field Loss: A common consequence of untreated glaucoma, including acute forms, which can lead to significant vision impairment.
5. Ocular Emergency: Acute angle-closure glaucoma is often classified as an ocular emergency due to the risk of rapid vision loss if not treated promptly.

Clinical Context

Acute angle-closure glaucoma is a medical emergency that requires immediate intervention to lower intraocular pressure and prevent permanent vision loss. Symptoms typically include severe eye pain, headache, nausea, vomiting, and blurred vision. Understanding the terminology surrounding this condition is crucial for healthcare professionals in both diagnosis and treatment planning.

In summary, recognizing the various names and related terms for acute angle-closure glaucoma can facilitate better communication among healthcare providers and improve patient care outcomes. If you have further questions or need additional information on this topic, feel free to ask!

Acute angle-closure glaucoma is a serious condition that requires prompt diagnosis and treatment to prevent vision loss. The ICD-10 code H40.21 specifically refers to this type of glaucoma, and the criteria for its diagnosis are based on clinical findings and patient symptoms. Below is a detailed overview of the diagnostic criteria for acute angle-closure glaucoma.

Clinical Presentation

Symptoms

Patients with acute angle-closure glaucoma typically present with a sudden onset of symptoms, which may include:
- Severe eye pain: Often described as intense and debilitating.
- Headache: Frequently accompanying the eye pain.
- Nausea and vomiting: These systemic symptoms can occur due to the severity of the eye pain.
- Blurred vision: Patients may experience sudden changes in visual acuity.
- Halos around lights: This phenomenon occurs due to corneal edema.

Physical Examination

A comprehensive eye examination is crucial for diagnosing acute angle-closure glaucoma. Key findings may include:
- Elevated intraocular pressure (IOP): Typically greater than 21 mmHg, but often significantly higher in acute cases.
- Corneal edema: The cornea may appear cloudy due to fluid accumulation.
- Mid-dilated pupil: The pupil may be non-reactive or poorly reactive to light.
- Shallow anterior chamber: This can be assessed using a slit lamp examination, revealing a narrow angle between the iris and cornea.

Diagnostic Tests

Gonioscopy

Gonioscopy is a specialized examination that allows the clinician to visualize the anterior chamber angle. In acute angle-closure glaucoma, the angle is typically closed or very narrow, preventing aqueous humor from draining properly.

Tonometry

Tonometry measures the intraocular pressure. In acute angle-closure glaucoma, the pressure is often markedly elevated, which is a critical diagnostic criterion.

Visual Field Testing

While not always performed immediately, visual field testing can help assess any damage to the optic nerve and the extent of vision loss.

Differential Diagnosis

It is essential to differentiate acute angle-closure glaucoma from other conditions that may present similarly, such as:
- Acute iritis: Inflammation of the iris can cause pain and photophobia but typically does not result in elevated IOP.
- Acute conjunctivitis: This condition may cause redness and discomfort but usually does not involve significant changes in vision or IOP.

Conclusion

The diagnosis of acute angle-closure glaucoma (ICD-10 code H40.21) relies on a combination of patient history, clinical symptoms, and specific examination findings. Prompt recognition and treatment are vital to prevent irreversible vision loss. If you suspect acute angle-closure glaucoma, immediate referral to an ophthalmologist is essential for further evaluation and management.

Acute angle-closure glaucoma (ICD-10 code H40.21) is a medical emergency characterized by a sudden increase in intraocular pressure due to the closure of the anterior chamber angle, which obstructs the outflow of aqueous humor. This condition can lead to rapid vision loss if not treated promptly. Here’s a detailed overview of the standard treatment approaches for managing acute angle-closure glaucoma.

Initial Management

1. Medical Treatment

The first step in managing acute angle-closure glaucoma involves pharmacological interventions aimed at lowering intraocular pressure (IOP) and alleviating symptoms:

• Topical Medications:
• Beta-blockers (e.g., Timolol) reduce aqueous humor production.
• Alpha agonists (e.g., Apraclonidine) decrease aqueous humor production and increase uveoscleral outflow.
• Carbonic anhydrase inhibitors (e.g., Dorzolamide) also reduce aqueous humor production.

• Prostaglandin analogs (e.g., Latanoprost) can enhance outflow but are typically not first-line in acute settings.

• Systemic Medications:

• Carbonic anhydrase inhibitors (e.g., Acetazolamide) can be administered orally or intravenously to rapidly decrease IOP.

• Osmotic agents (e.g., Mannitol) are used to draw fluid out of the eye and reduce IOP quickly.

• Pilocarpine: Once the IOP is lowered, pilocarpine, a miotic agent, can be used to constrict the pupil and help open the angle, facilitating aqueous outflow.

2. Pain Management

Patients often experience significant pain and discomfort. Analgesics may be administered to manage pain effectively during the acute phase.

Definitive Treatment

3. Laser Therapy

Once the IOP is stabilized, definitive treatment typically involves laser procedures:

• Laser Peripheral Iridotomy (LPI): This is the most common and effective treatment for acute angle-closure glaucoma. It involves creating a small hole in the peripheral iris using a laser, which allows aqueous humor to bypass the blocked angle and flow freely into the anterior chamber.

• Laser Iridoplasty: In cases where LPI is not feasible, laser iridoplasty may be performed to stretch the peripheral iris and open the angle.

4. Surgical Options

If laser treatment is not successful or if the patient has recurrent episodes, surgical options may be considered:

• Goniotomy: This procedure involves surgically incising the trabecular meshwork to improve aqueous outflow.
• Trabeculectomy: In more severe cases, a trabeculectomy may be performed to create a new drainage pathway for aqueous humor.

Post-Treatment Care

5. Follow-Up and Monitoring

After treatment, patients require close monitoring to ensure that IOP remains within normal limits and to assess for any complications. Regular follow-up visits are essential to manage any ongoing risk of glaucoma.

6. Patient Education

Educating patients about the signs and symptoms of angle-closure glaucoma is crucial for early detection and treatment. Patients should be informed about the importance of adhering to prescribed medications and attending follow-up appointments.

Conclusion

Acute angle-closure glaucoma is a serious condition that requires immediate medical attention. The standard treatment approaches focus on rapidly lowering intraocular pressure through medical management, followed by definitive laser or surgical interventions. Early recognition and treatment are vital to prevent permanent vision loss, making patient education and follow-up care essential components of management.