ICD-10: H40.213

Acute angle-closure glaucoma is a serious ocular condition characterized by a sudden increase in intraocular pressure (IOP) due to the blockage of the anterior chamber angle, which impedes the outflow of aqueous humor. The ICD-10 code H40.213 specifically refers to acute angle-closure glaucoma that occurs bilaterally, meaning it affects both eyes.

Clinical Description

Pathophysiology

In acute angle-closure glaucoma, the iris is pushed forward, obstructing the drainage angle formed by the cornea and the iris. This blockage leads to a rapid rise in IOP, which can cause significant damage to the optic nerve if not treated promptly. The condition is often precipitated by factors such as pupil dilation, which can occur in low-light conditions or as a side effect of certain medications.

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: Can be localized or generalized.
- Nausea and vomiting: Due to the intense pain and increased IOP.
- Visual disturbances: Such as blurred vision or seeing halos around lights.
- Redness of the eye: Due to conjunctival injection.
- Mid-dilated pupil: The pupil may be non-reactive to light.

Diagnosis

Diagnosis is primarily clinical, supported by:
- Tonometry: To measure IOP, which is typically elevated (often > 30 mmHg).
- Gonioscopy: To assess the angle of the anterior chamber and confirm the presence of angle closure.
- Fundoscopy: To evaluate the optic nerve for signs of damage.

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: Such as laser peripheral iridotomy, which creates a new drainage pathway for aqueous humor.
- Surgical intervention: In some cases, surgical procedures may be necessary to correct the anatomical issues causing the angle closure.

Coding Details

The ICD-10 code H40.213 is part of the broader category of glaucoma codes (H40) and specifically denotes:
- Acute angle-closure glaucoma: A critical condition requiring urgent care.
- Bilateral: Indicating that both eyes are affected, which can complicate treatment and management strategies.

Importance of Accurate Coding

Accurate coding is essential for proper billing, insurance reimbursement, and tracking of healthcare statistics. The specificity of the H40.213 code helps healthcare providers communicate the severity and nature of the condition effectively.

In summary, acute angle-closure glaucoma (ICD-10 code H40.213) is a medical emergency that necessitates immediate intervention to prevent irreversible damage to the optic nerve and preserve vision. Understanding its clinical presentation, diagnostic criteria, and treatment options is vital for healthcare professionals managing patients with this condition.

Acute angle-closure glaucoma (AACG) is a serious ocular condition characterized by a rapid increase in intraocular pressure due to the obstruction of aqueous humor outflow. This condition can lead to irreversible vision loss if not treated promptly. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with ICD-10 code H40.213, which specifically refers to bilateral acute angle-closure glaucoma.

Clinical Presentation

Symptoms

Patients with bilateral acute angle-closure glaucoma often present with a range of acute symptoms, which may include:

• Severe Eye Pain: Patients typically report intense pain in the affected eyes, which can radiate to the forehead or temples.
• Headache: A significant headache, often described as a throbbing pain, may accompany the ocular symptoms.
• Nausea and Vomiting: Due to the severity of the pain, patients may experience gastrointestinal symptoms, including nausea and vomiting.
• Blurred Vision: Sudden changes in vision, including blurriness or halos around lights, are common.
• Redness of the Eye: The affected eye may appear red due to conjunctival injection.
• Photophobia: Increased sensitivity to light can occur, making it uncomfortable for patients to be in well-lit environments.

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.
• Corneal Edema: The cornea may appear cloudy or edematous due to increased pressure.
• Mid-Dilated Pupil: The pupil may be non-reactive and mid-dilated, indicating a failure of the iris to respond to light.
• Shallow Anterior Chamber: A shallow anterior chamber can be noted during slit-lamp examination, which is a hallmark of angle-closure.
• Ciliary Injection: There may be a circumlimbal injection, which is redness around the cornea.

Patient Characteristics

Demographics

Certain demographic factors can predispose individuals to acute angle-closure glaucoma:

• Age: AACG is more common in older adults, particularly those over the age of 60.
• Gender: Women are at a higher risk than men, possibly due to anatomical differences in the eye.
• Ethnicity: Individuals of Asian descent are more frequently affected, likely due to anatomical predispositions such as a narrower anterior chamber angle.

Risk Factors

Several risk factors can contribute to the development of acute angle-closure glaucoma:

• Family History: A family history of glaucoma can increase the likelihood of developing AACG.
• Hyperopia (Farsightedness): Individuals with hyperopia may have a shallower anterior chamber, increasing the risk of angle closure.
• Use of Certain Medications: Medications that dilate the pupil, such as anticholinergics, can precipitate an attack in susceptible individuals.

Conclusion

Acute angle-closure glaucoma is a medical emergency that requires immediate attention to prevent permanent vision loss. Recognizing the clinical presentation, including the hallmark symptoms and signs, is crucial for timely diagnosis and treatment. Understanding patient characteristics and risk factors can aid healthcare providers in identifying at-risk individuals and implementing preventive measures. If you suspect a patient may be experiencing symptoms of AACG, prompt referral to an ophthalmologist is essential for appropriate management and intervention.

Acute angle-closure glaucoma is a serious condition that requires prompt medical attention. The ICD-10-CM code H40.213 specifically refers to acute angle-closure glaucoma affecting both eyes. Understanding alternative names and related terms can help in better communication among healthcare professionals and in the documentation process.

Alternative Names for Acute Angle-Closure Glaucoma

1. Acute Closed-Angle Glaucoma: This term emphasizes the acute nature of the condition and the closure of the angle in the eye.
2. Acute Angle-Closure Glaucoma: A slight variation in phrasing, but commonly used interchangeably with H40.213.
3. Bilateral Angle-Closure Glaucoma: This term highlights that the condition affects both eyes, which is crucial for diagnosis and treatment.
4. Acute Glaucoma: While this term is broader, it can sometimes refer to acute angle-closure glaucoma specifically, depending on the context.
5. Primary Angle-Closure Glaucoma: This term may be used when the condition is not secondary to other factors, although it is more general and can include unilateral cases as well.

Related Terms

1. Glaucoma: A general term for a group of eye conditions that damage the optic nerve, often associated with increased intraocular pressure.
2. Intraocular Pressure (IOP): A key factor in glaucoma, where elevated IOP can lead to damage of the optic nerve.
3. Visual Field Loss: A common consequence of untreated angle-closure glaucoma, where peripheral vision is affected.
4. Pupil Block: A mechanism often involved in acute angle-closure glaucoma, where the iris obstructs the drainage angle of the eye.
5. Ocular Hypertension: A condition where the pressure inside the eye is higher than normal, which can lead to glaucoma if not managed.

Conclusion

Understanding the various names and related terms for ICD-10 code H40.213 is essential for accurate diagnosis, treatment, and communication in clinical settings. These terms not only facilitate better understanding among healthcare providers but also enhance patient education regarding their condition. If you have further questions or need more specific information, feel free to ask!

Acute angle-closure glaucoma (AACG) is a serious condition that requires prompt diagnosis and treatment to prevent vision loss. The ICD-10 code H40.213 specifically refers to bilateral acute angle-closure glaucoma. 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

During the examination, several key findings may indicate acute angle-closure glaucoma:
- Elevated intraocular pressure (IOP): IOP is typically significantly higher than normal (greater than 21 mmHg).
- 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: A gonioscopic examination may reveal a narrow or closed angle.

Diagnostic Tests

Tonometry

• Intraocular Pressure Measurement: Tonometry is performed to measure the IOP, which is usually elevated in cases of acute angle-closure glaucoma.

Gonioscopy

• Angle Assessment: Gonioscopy is essential for visualizing the anterior chamber angle. In acute angle-closure glaucoma, the angle is typically closed or very narrow.

Visual Field Testing

• Assessment of Visual Function: Visual field tests may be conducted to evaluate any loss of peripheral vision, which can occur due to increased IOP.

Optical Coherence Tomography (OCT)

• Imaging of Anterior Segment: OCT can be used to assess the anatomy of the anterior chamber and confirm angle closure.

Differential Diagnosis

It is crucial 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 pain or elevated IOP.

Conclusion

The diagnosis of bilateral acute angle-closure glaucoma (ICD-10 code H40.213) is based on a combination of clinical symptoms, physical examination findings, and diagnostic tests. 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 essential for further evaluation and management[1][2][3].

Acute angle-closure glaucoma (ICD-10 code H40.213) is a serious ocular condition characterized by a sudden increase in intraocular pressure due to the closure of the anterior chamber angle, which can lead to vision loss if not treated promptly. The management of this condition typically involves both immediate and long-term treatment strategies aimed at reducing intraocular pressure and preventing future episodes. Below is a detailed overview of standard treatment approaches for acute angle-closure glaucoma.

Immediate Treatment

1. Medications

The first step in managing acute angle-closure glaucoma is to lower intraocular pressure (IOP) quickly. This is often achieved through a combination of medications:

• 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 less effective 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 pressure quickly.

2. Pilocarpine

Once the IOP is lowered sufficiently (usually after 30-60 minutes of initial treatment), Pilocarpine, a miotic agent, is administered to constrict the pupil and help open the angle, facilitating aqueous humor outflow.

3. Laser Treatment

• Laser Peripheral Iridotomy (LPI): This is often performed as an urgent procedure to create a new drainage pathway for aqueous humor, effectively relieving the angle closure. LPI is considered the definitive treatment and is typically performed once the IOP is stabilized.

Long-term Management

1. Surgical Options

For patients with recurrent episodes or those who cannot undergo laser treatment, surgical options may be considered:
- Goniotomy or Trabeculectomy may be performed to create a new drainage pathway for aqueous humor.
- Aqueous shunt surgery may be indicated in certain cases, especially in patients with significant risk factors for angle closure.

2. Medications for Maintenance

After the acute episode is managed, patients may require ongoing treatment to control IOP and prevent future attacks:
- Topical medications similar to those used in the acute phase may be prescribed for long-term management.
- Regular follow-up visits are essential to monitor IOP and assess the effectiveness of the treatment regimen.

Patient Education and Follow-Up

Educating patients about the signs and symptoms of acute angle-closure glaucoma is crucial for early detection and treatment. Patients should be advised to seek immediate medical attention if they experience sudden vision changes, severe eye pain, headache, or nausea.

Regular follow-up appointments are necessary to monitor the condition and adjust treatment as needed. Patients with a history of angle-closure glaucoma may also benefit from preventive measures, such as prophylactic laser treatment in the fellow eye if it is at risk.

Conclusion

Acute angle-closure glaucoma is a medical emergency that requires prompt treatment to prevent vision loss. The standard treatment approach involves a combination of medications to lower intraocular pressure, laser procedures to relieve the angle closure, and ongoing management strategies to prevent recurrence. Early recognition and intervention are key to successful outcomes in patients with this condition.