ICD-10: H40.219

Acute angle-closure glaucoma is a serious ocular condition characterized by a sudden increase in intraocular pressure due to the blockage of the drainage angle in the eye. The ICD-10 code H40.219 specifically refers to acute angle-closure glaucoma when the affected eye is unspecified, meaning that the documentation does not specify whether it is the right or left eye.

Clinical Description

Definition

Acute angle-closure glaucoma occurs when the iris is pushed or pulled forward, narrowing or closing the angle between the iris and the cornea. This blockage prevents aqueous humor from draining out of the eye, leading to a rapid increase in intraocular pressure, which can cause severe pain and potential vision loss if not treated promptly.

Symptoms

Patients with acute angle-closure glaucoma may experience a range of symptoms, including:
- Severe eye pain: Often described as a deep, aching pain.
- Headache: Typically localized around the eye or forehead.
- Nausea and vomiting: Due to the intense pain and pressure.
- Blurred vision: Sudden changes in vision quality.
- Halos around lights: A common visual disturbance due to corneal edema.
- Redness of the eye: Indicative of increased pressure and inflammation.

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 exist.
- Pre-existing eye conditions: Such as hyperopia (farsightedness) or a shallow anterior chamber.

Diagnosis

Diagnosis of acute angle-closure glaucoma typically involves:
- Clinical examination: Using a slit lamp to assess the angle and intraocular pressure.
- Tonometry: Measuring the pressure inside the eye.
- Gonioscopy: A specialized test to visualize the drainage angle.

Treatment

Immediate treatment is crucial to prevent permanent vision loss. Options include:
- Medications: To lower intraocular pressure, such as carbonic anhydrase inhibitors, beta-blockers, and prostaglandin analogs.
- 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 underlying anatomical issues.

Coding and Documentation

The ICD-10 code H40.219 is used for billing and coding purposes in healthcare settings. Accurate documentation is essential for proper coding, which includes:
- Patient symptoms: Documenting the onset and nature of symptoms.
- Examination findings: Results from tonometry and gonioscopy.
- Treatment provided: Details of medications administered and any surgical interventions performed.

In summary, acute angle-closure glaucoma is a medical emergency requiring prompt diagnosis and treatment to prevent irreversible damage to the optic nerve and vision loss. The ICD-10 code H40.219 serves as a critical identifier for healthcare providers in managing this condition effectively.

Acute angle-closure glaucoma is a serious condition that requires prompt diagnosis and treatment to prevent vision loss. The ICD-10 code H40.219 specifically refers to acute angle-closure glaucoma in an unspecified 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

During a comprehensive eye examination, several key findings may indicate acute angle-closure glaucoma:
- Elevated intraocular pressure (IOP): Typically, IOP is significantly higher than the normal range (10-21 mmHg), often exceeding 30 mmHg in acute cases.
- Corneal edema: The cornea may appear cloudy or swollen due to increased pressure.
- 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 between the iris and cornea.

Diagnostic Tests

Tonometry

Tonometry is used to measure intraocular pressure. In acute angle-closure glaucoma, the IOP is usually markedly elevated.

Gonioscopy

This procedure allows for direct visualization of the anterior chamber angle. In acute angle-closure glaucoma, the angle is often closed or very narrow, confirming the diagnosis.

Visual Field Testing

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

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 is not associated with increased IOP.
- Other types of glaucoma: Open-angle glaucoma and secondary glaucomas should also be considered.

Conclusion

The diagnosis of acute angle-closure glaucoma (ICD-10 code H40.219) is based on a combination of clinical symptoms, physical examination findings, and specific diagnostic tests. Prompt recognition and treatment are essential to prevent irreversible vision loss. If you suspect acute angle-closure glaucoma, immediate referral to an ophthalmologist is critical for management and intervention.

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 H40.219 specifically refers to acute angle-closure glaucoma in an unspecified 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 be localized to the affected eye but may also radiate to the forehead or temple.
• Headache: Patients may experience a significant headache, often accompanying the eye pain.
• Nausea and Vomiting: Due to the severity of the pain, patients may also experience gastrointestinal symptoms, including nausea and vomiting.
• Blurred Vision: Vision may become hazy or blurred, often due to corneal edema caused by elevated IOP.
• Halos Around Lights: Patients may report seeing halos around lights, a phenomenon caused by corneal swelling.

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 mid-dilated, non-reactive pupil due to iris ischemia.
• Corneal Edema: The cornea may appear cloudy or edematous, indicating fluid accumulation.
• Conjunctival Injection: There may be redness of the conjunctiva, often described as a "ciliary flush."
• 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 are associated with a higher risk of developing 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 prone to angle-closure glaucoma, likely due to anatomical predispositions.

Medical History

Patients with a history of certain conditions may also be at increased risk:

• Family History: A family history of glaucoma can increase the likelihood of developing AACG.
• Previous Eye Conditions: Individuals with a history of eye surgery or trauma may be more susceptible.
• Systemic Conditions: Conditions such as diabetes and hyperopia (farsightedness) can contribute to the risk of angle-closure.

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, including medications to lower IOP and potential surgical intervention, is essential for preserving vision and alleviating symptoms.

Acute angle-closure glaucoma, classified under the ICD-10 code H40.219, is a specific type of glaucoma characterized by a sudden increase in intraocular pressure due to the closure of the angle between the iris and cornea. This condition can lead to severe vision loss if not treated promptly. Below are alternative names and related terms associated with this condition.

Alternative Names

1. Acute Closed-Angle Glaucoma: This term emphasizes the acute nature of the condition and the closure of the drainage angle in the eye.
2. Acute Angle-Closure Glaucoma: A variation of the primary name, often used interchangeably.
3. Acute Glaucoma: A broader term that may refer to any sudden onset of glaucoma, but often implies angle-closure when used in context.
4. Angle-Closure Glaucoma: This term can refer to both acute and chronic forms but is often associated with the acute presentation.

Related Terms

1. Primary Angle-Closure Disease: This term refers to the underlying condition that can lead to acute angle-closure glaucoma, characterized by anatomical predispositions.
2. Secondary Angle-Closure Glaucoma: This term describes angle-closure glaucoma that occurs due to other conditions, such as inflammation or tumors.
3. Intraocular Pressure (IOP): A critical measurement in diagnosing and managing glaucoma, including acute angle-closure types.
4. Ocular Hypertension: While not synonymous, this term is related as it describes elevated intraocular pressure, which can be a precursor to glaucoma.
5. Glaucomatous Crisis: A term that may be used to describe the acute and severe symptoms associated with angle-closure glaucoma.

Clinical Context

Understanding these alternative names and related terms is essential for healthcare professionals involved in the diagnosis and treatment of glaucoma. Accurate terminology ensures effective communication among medical staff and aids in the proper coding and billing processes related to ophthalmic care.

In summary, the ICD-10 code H40.219 encompasses various terminologies that reflect the acute nature of angle-closure glaucoma, its clinical implications, and its relationship to other forms of glaucoma. Proper identification and understanding of these terms are crucial for effective patient management and treatment strategies.

Acute angle-closure glaucoma (ICD-10 code H40.219) 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. Here, we will explore the standard treatment approaches for this condition, including both immediate and long-term management strategies.

Immediate Treatment Approaches

1. Medications

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

• Carbonic Anhydrase Inhibitors: Drugs such as acetazolamide can reduce aqueous humor production, thereby lowering IOP.
• Topical Beta-Blockers: Medications like timolol can decrease aqueous humor production.
• Alpha Agonists: Apraclonidine or brimonidine can also help reduce IOP.
• Prostaglandin Analogs: These can increase aqueous outflow, although they are not typically the first choice in acute settings.
• Mannitol: An osmotic agent administered intravenously to rapidly decrease IOP by drawing fluid out of the eye.

2. Pilocarpine

Once the IOP is lowered, pilocarpine, a miotic agent, may be used to constrict the pupil and facilitate the opening of the drainage angle. However, it is usually administered after the IOP has been reduced to avoid exacerbating the condition initially.

3. Systemic Support

Patients may require systemic support, including pain management and antiemetics, as acute angle-closure glaucoma can cause significant discomfort and nausea.

Surgical Interventions

1. Laser Peripheral Iridotomy (LPI)

Once the IOP is stabilized, the definitive treatment for acute angle-closure glaucoma is often laser peripheral iridotomy. This procedure creates a small hole in the peripheral iris, allowing aqueous humor to bypass the blocked angle and flow freely into the anterior chamber. LPI is effective in preventing future episodes of angle closure.

2. Surgical Iridectomy

In some cases, a surgical iridectomy may be performed, especially if laser treatment is not feasible or if there are complications.

Long-term Management

1. Follow-up Care

Patients diagnosed with acute angle-closure glaucoma require regular follow-up to monitor IOP and assess the need for additional treatments. This may include periodic visual field testing and optic nerve evaluation.

2. Preventive Measures

For patients at risk of recurrent angle-closure episodes, preventive measures such as prophylactic LPI in the fellow eye may be recommended, especially if there is a history of angle closure.

3. Medications

Long-term management may also involve the use of medications to control IOP, including topical medications and oral carbonic anhydrase inhibitors, depending on the individual patient's needs.

Conclusion

Acute angle-closure glaucoma is a serious condition that requires immediate medical attention. The standard treatment approaches involve a combination of medications to lower IOP, followed by surgical interventions such as laser peripheral iridotomy to prevent future episodes. Ongoing management and follow-up care are essential to ensure the health of the eye and preserve vision. If you suspect acute angle-closure glaucoma, it is crucial to seek emergency care promptly to minimize the risk of permanent vision loss.