ICD-10: H40.211

Acute angle-closure glaucoma is a serious ocular condition characterized by a sudden increase in intraocular pressure (IOP) due to the obstruction of the anterior chamber angle, which impedes the outflow of aqueous humor. The ICD-10-CM code H40.211 specifically denotes acute angle-closure glaucoma affecting the right eye.

Clinical Description

Definition

Acute angle-closure glaucoma occurs when the drainage angle formed by the cornea and iris becomes blocked, leading to a rapid rise in IOP. This condition is considered a medical emergency due to the potential for irreversible vision loss if not treated promptly.

Symptoms

Patients with acute angle-closure glaucoma may present with a variety of symptoms, including:
- Severe eye pain: Often described as intense and debilitating.
- Headache: Typically localized to the affected side.
- Nausea and vomiting: These systemic symptoms can occur due to the severity of the pain.
- Blurred vision: Patients may experience sudden changes 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 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.
- Hyperopia (farsightedness): Individuals with hyperopia may have a shallower anterior chamber.
- Family history: A genetic predisposition can play a role.
- Certain medications: Some drugs can precipitate angle closure.

Diagnosis

Diagnosis of acute angle-closure glaucoma typically involves:
- Clinical examination: An ophthalmologist will assess the eye for signs of increased IOP, corneal edema, and a closed or narrow angle.
- Tonometry: Measurement of IOP, which is often significantly elevated in acute cases.
- Gonioscopy: A specialized examination to visualize the anterior chamber angle.

Treatment

Immediate treatment is crucial to prevent permanent vision loss. Management strategies may include:
- Medications: To lower IOP, including carbonic anhydrase inhibitors, beta-blockers, and topical prostaglandins.
- Pilocarpine: A miotic agent that can help 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.

Conclusion

ICD-10 code H40.211 is essential for accurately documenting and billing for acute angle-closure glaucoma affecting the right eye. Understanding the clinical presentation, risk factors, and treatment options is vital for healthcare providers to manage this urgent condition effectively. Prompt recognition and intervention can significantly improve patient outcomes and preserve vision.

Acute angle-closure glaucoma (AACG) is a serious ocular condition characterized by a rapid increase in intraocular pressure (IOP) due to the obstruction of aqueous humor outflow. The ICD-10 code H40.211 specifically refers to acute angle-closure glaucoma affecting the right eye. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for timely diagnosis and management.

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 throbbing, this pain can radiate to the forehead or temple.
• Headache: A generalized headache may accompany the eye pain.
• Nausea and Vomiting: Due to the severity of the pain, patients may experience gastrointestinal symptoms.
• Blurred Vision: Vision may become hazy or cloudy, often due to corneal edema.
• Halos Around Lights: Patients may report seeing halos around lights, a result of corneal swelling and increased IOP.

Signs

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

• Elevated Intraocular Pressure: IOP is typically significantly elevated, often exceeding 30 mmHg.
• Mid-Dilated Pupil: The affected eye may exhibit a non-reactive, mid-dilated pupil due to iris ischemia.
• Corneal Edema: The cornea may appear cloudy or hazy due to fluid accumulation.
• Conjunctival Injection: There may be redness of the conjunctiva, indicating inflammation.
• Shallow Anterior Chamber: A thorough examination may reveal a shallow anterior chamber, which is a hallmark of angle-closure.

Patient Characteristics

Demographics

Certain demographic factors can influence the 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, possibly due to anatomical differences in the eye.
• Ethnicity: Individuals of Asian descent are more prone to angle-closure glaucoma due to anatomical predispositions.

Medical History

Patients with a history of certain conditions may be more susceptible to AACG:

• Family History: A family history of glaucoma can increase risk.
• Previous Eye Surgery: Individuals who have undergone cataract surgery or other ocular procedures may have altered anatomy that predisposes them to angle closure.
• Hyperopia: Farsighted individuals are at greater risk due to the anatomical configuration of their eyes.

Other Risk Factors

Additional factors that may contribute to the development of acute angle-closure glaucoma include:

• Medications: Certain medications, such as anticholinergics, can precipitate angle closure.
• Pupil Dilation: Situations that cause pupil dilation, such as dark environments or the use of mydriatic agents, can trigger an acute attack.

Conclusion

Acute angle-closure glaucoma is a medical emergency that requires prompt recognition and treatment to prevent permanent vision loss. The clinical presentation is characterized by severe eye pain, headache, nausea, blurred vision, and specific ocular signs such as elevated IOP and corneal edema. Understanding the patient characteristics, including age, gender, ethnicity, and medical history, can aid in identifying at-risk individuals and facilitating early intervention. Timely management, often involving medications to lower IOP and surgical intervention to relieve the angle obstruction, is essential for preserving vision in affected patients.

Acute angle-closure glaucoma is a serious eye condition that requires prompt medical attention. The ICD-10 code H40.211 specifically refers to acute angle-closure glaucoma affecting the right eye. Below are alternative names and related terms associated with this condition.

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 of angle-closure glaucoma.
3. Closed-Angle Glaucoma: Another term that highlights the mechanism of the condition, where the angle between the iris and cornea is closed, preventing proper drainage of aqueous humor.
4. Narrow-Angle Glaucoma: This term refers to the anatomical configuration that predisposes individuals to angle-closure glaucoma, although it may not specify the acute nature of the condition.

Related Terms

1. Intraocular Pressure (IOP): A critical measurement in diagnosing glaucoma, as elevated IOP is a common feature of acute angle-closure glaucoma.
2. Pupil Block: A mechanism that can lead to acute angle-closure glaucoma, where the iris obstructs the flow of aqueous humor.
3. Glaucoma Attack: Refers to the acute episode of increased intraocular pressure and associated symptoms.
4. Visual Field Loss: A potential consequence of untreated acute angle-closure glaucoma, highlighting the importance of early diagnosis and treatment.
5. Ocular Emergency: Acute angle-closure glaucoma is classified as an ocular emergency due to the risk of permanent vision loss if not treated promptly.

Clinical Context

Acute angle-closure glaucoma is characterized by a rapid increase in intraocular pressure, often accompanied by symptoms such as severe eye pain, headache, nausea, vomiting, and blurred vision. Immediate medical intervention is crucial to prevent irreversible damage to the optic nerve and vision loss[1][2].

Understanding these alternative names and related terms can aid healthcare professionals in accurately diagnosing and communicating about this condition, ensuring timely and effective treatment for patients.

Acute angle-closure glaucoma is a serious condition that requires prompt diagnosis and treatment to prevent vision loss. The ICD-10 code H40.211 specifically refers to acute angle-closure glaucoma affecting the right eye. Here’s a detailed overview of the criteria used for diagnosing this condition.

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 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 diagnosis. Key components include:

• Visual Acuity Testing: Assessing the clarity of vision can help determine the extent of visual impairment.
• Intraocular Pressure (IOP) Measurement: Elevated IOP is a hallmark of acute angle-closure glaucoma. Normal IOP ranges from 10 to 21 mmHg; values significantly above this range suggest glaucoma.
• Pupil Examination: A mid-dilated, non-reactive pupil is often observed in acute angle-closure glaucoma.
• Corneal Edema: The cornea may appear cloudy due to fluid accumulation, which can be assessed through slit-lamp examination.

Gonioscopy

Gonioscopy is a critical diagnostic tool in evaluating the anterior chamber angle. This procedure involves using a special lens to visualize the angle between the iris and the cornea. In acute angle-closure glaucoma, the angle is typically closed or very narrow, preventing aqueous humor from draining properly.

Additional Diagnostic Tests

• Optic Nerve Assessment: Evaluation of the optic nerve head for signs of damage or cupping can provide insights into the chronicity of the condition.
• Visual Field Testing: This may be performed to assess any peripheral vision loss, which can occur in advanced cases.

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 lead to significant vision changes or elevated IOP.

Conclusion

The diagnosis of acute angle-closure glaucoma (ICD-10 code H40.211) is based on a combination of clinical symptoms, physical examination findings, and specialized tests such as gonioscopy. Prompt recognition and treatment are vital to prevent irreversible damage to the optic nerve and preserve vision. If you suspect acute angle-closure glaucoma, immediate referral to an ophthalmologist is critical for management.

Acute angle-closure glaucoma (ICD-10 code H40.211) is a medical emergency characterized by a sudden increase in intraocular pressure due to the blockage of the drainage angle in the eye. This condition can lead to severe vision loss if not treated promptly. The standard treatment approaches for acute angle-closure glaucoma involve both immediate management to lower intraocular pressure and longer-term strategies to prevent recurrence.

Immediate Treatment

1. Medications

• Topical Medications: The first line of treatment typically includes topical medications such as:
  • Beta-blockers (e.g., Timolol) to reduce aqueous humor production.
  • Alpha agonists (e.g., Apraclonidine) to decrease aqueous humor production and increase uveoscleral outflow.
  • Carbonic anhydrase inhibitors (e.g., Dorzolamide) to further reduce aqueous humor production.
  • Prostaglandin analogs (e.g., Latanoprost) may also be used to enhance outflow.
• Oral Medications: Carbonic anhydrase inhibitors (e.g., Acetazolamide) can be administered orally to provide systemic reduction of aqueous humor production.
• Mannitol: An intravenous hyperosmotic agent, mannitol is often used to rapidly decrease intraocular pressure by drawing fluid out of the eye.

2. Pilocarpine

• After the intraocular pressure is lowered, pilocarpine, a miotic agent, is used to constrict the pupil and open the drainage angle, facilitating aqueous outflow.

3. Laser Therapy

• Laser Peripheral Iridotomy (LPI): This is a definitive treatment performed to create a new drainage pathway for aqueous humor. It is typically done once the pressure is stabilized and is crucial for preventing future episodes of angle-closure glaucoma.

Surgical Options

1. Surgical Intervention

• In cases where laser treatment is not feasible or if the patient has significant anatomical issues, surgical options may be considered. These can include:
  • Iridectomy: Surgical removal of a portion of the iris to create a new drainage pathway.
  • Aqueous Shunts: In some cases, aqueous shunts may be placed to facilitate fluid drainage.

Long-term Management

1. Follow-up Care

• Regular follow-up appointments are essential to monitor intraocular pressure and assess the effectiveness of the treatment. Patients may require ongoing medication to manage intraocular pressure.

2. Patient Education

• Educating patients about the signs and symptoms of acute angle-closure glaucoma is vital. They should be informed about the importance of seeking immediate medical attention if they experience symptoms such as severe eye pain, headache, nausea, vomiting, or sudden vision changes.

3. Preventive Measures

• For patients with a history of angle-closure glaucoma, preventive measures such as prophylactic laser peripheral iridotomy in the fellow eye may be recommended to reduce the risk of future episodes.

Conclusion

Acute angle-closure glaucoma is a serious condition requiring prompt and effective treatment to prevent vision loss. The standard treatment approaches include a combination of medications to lower intraocular pressure, laser therapy to create new drainage pathways, and ongoing management to prevent recurrence. Early recognition and intervention are crucial for favorable outcomes in patients diagnosed with this condition. Regular follow-up and patient education play significant roles in long-term management and prevention strategies.