ICD-10: H40.22

Chronic angle-closure glaucoma, classified under ICD-10 code H40.22, is a specific type of glaucoma characterized by a gradual closure of the anterior chamber angle, leading to increased intraocular pressure (IOP) and potential damage to the optic nerve. This condition is part of the broader category of glaucoma codes (H40-H42) and is crucial for accurate diagnosis and treatment in ophthalmology.

Clinical Description

Definition

Chronic angle-closure glaucoma occurs when the drainage angle formed by the cornea and iris becomes obstructed, preventing aqueous humor from draining properly. This obstruction can lead to a gradual increase in IOP, which may not present immediate symptoms but can result in significant optic nerve damage over time if left untreated.

Symptoms

Patients with chronic angle-closure glaucoma may experience:
- Visual disturbances: Blurred vision or halos around lights.
- Eye discomfort: A feeling of pressure or pain in the eye.
- Headaches: Often associated with increased IOP.
- Nausea and vomiting: In some cases, particularly during acute episodes.

Risk Factors

Several factors can increase the risk of developing chronic angle-closure glaucoma, including:
- Age: Older adults are at higher risk.
- Ethnicity: Certain populations, such as those of Asian descent, have a higher prevalence.
- Family history: A genetic predisposition may play a role.
- Anatomical features: Individuals with a shallow anterior chamber or a thick lens are more susceptible.

Diagnosis

Clinical Examination

Diagnosis typically involves a comprehensive eye examination, including:
- Tonometry: To measure IOP.
- Gonioscopy: To assess the angle of the anterior chamber.
- Visual field testing: To evaluate any loss of peripheral vision.
- Optic nerve assessment: Using imaging techniques to check for damage.

Classification

Chronic angle-closure glaucoma is often classified based on the severity of the angle closure and the degree of optic nerve damage. It is essential to differentiate it from acute angle-closure glaucoma, which presents with sudden symptoms and requires immediate intervention.

Management and Treatment

Medical Management

Initial treatment may involve:
- Topical medications: Such as prostaglandin analogs, beta-blockers, or carbonic anhydrase inhibitors to lower IOP.
- Oral medications: Acetazolamide may be prescribed to reduce aqueous humor production.

Surgical Options

In cases where medical management is insufficient, surgical interventions may be necessary:
- Laser peripheral iridotomy: A common procedure that creates a small hole in the peripheral iris to improve aqueous humor drainage.
- Trabeculectomy: A surgical procedure that creates a new drainage pathway for aqueous humor.

Conclusion

Chronic angle-closure glaucoma is a serious condition that requires timely diagnosis and management to prevent irreversible vision loss. Understanding its clinical features, risk factors, and treatment options is essential for healthcare providers in ophthalmology. Regular eye examinations are crucial for early detection, especially in at-risk populations, to ensure effective management of this potentially debilitating condition.

Chronic angle-closure glaucoma, classified under ICD-10 code H40.22, is a significant ocular condition characterized by a gradual and progressive increase in intraocular pressure (IOP) due to the closure of the anterior chamber angle. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management.

Clinical Presentation

Chronic angle-closure glaucoma often develops insidiously, making it less apparent in its early stages. Patients may not experience acute symptoms initially, which can lead to delayed diagnosis. The condition is typically characterized by:

• Gradual Vision Loss: Patients may report a slow decline in vision, often described as a "foggy" or "hazy" vision, which can be mistaken for other age-related changes.
• Increased Intraocular Pressure: Regular eye examinations may reveal elevated IOP, which is a hallmark of glaucoma.

Signs and Symptoms

The signs and symptoms of chronic angle-closure glaucoma can vary, but common indicators include:

• Visual Disturbances: Patients may experience blurred vision, particularly in low-light conditions, due to the narrowing of the visual field.
• Halos Around Lights: Patients often report seeing halos around lights, especially at night, which is caused by corneal edema due to elevated IOP.
• Eye Pain or Discomfort: While chronic cases may not present with acute pain, patients can experience a dull ache or discomfort in the eye.
• Redness of the Eye: Conjunctival injection may be observed during an eye examination.
• Corneal Edema: Swelling of the cornea can occur, leading to further visual impairment.

Patient Characteristics

Certain demographic and clinical characteristics are associated with chronic angle-closure glaucoma:

• Age: The condition is more prevalent in older adults, particularly those over the age of 60, as the risk of angle closure increases with age.
• Gender: Women are more frequently affected than men, possibly due to anatomical differences in the eye.
• Ethnicity: Certain ethnic groups, particularly those of Asian descent, have a higher incidence of angle-closure glaucoma due to anatomical predispositions.
• Family History: A family history of glaucoma can increase the risk of developing chronic angle-closure glaucoma, indicating a genetic component to the disease.
• Other Ocular Conditions: Patients with other eye conditions, such as cataracts or hyperopia (farsightedness), may be at increased risk due to anatomical factors that predispose them to angle closure.

Conclusion

Chronic angle-closure glaucoma is a serious condition that requires careful monitoring and management. Early detection through regular eye examinations is essential, especially for at-risk populations. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition can aid healthcare providers in making timely diagnoses and implementing appropriate treatment strategies. Regular follow-ups and patient education about the importance of monitoring eye health are crucial in managing this potentially sight-threatening condition effectively.

Chronic angle-closure glaucoma, designated by the ICD-10 code H40.22, is a specific type of glaucoma characterized by a gradual closure of the angle between the iris and cornea, leading to increased intraocular pressure and potential vision loss. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Below are some of the key alternative names and related terms associated with H40.22.

Alternative Names

1. Chronic Closed-Angle Glaucoma: This term emphasizes the chronic nature of the condition and the closure of the angle.
2. Chronic Narrow-Angle Glaucoma: This name highlights the narrowing of the angle, which is a critical aspect of the disease.
3. Chronic Angle-Closure Glaucoma: A slight variation that omits the term "closure" but retains the essential meaning.
4. Secondary Angle-Closure Glaucoma: In some contexts, chronic angle-closure glaucoma may be referred to as secondary if it arises due to other ocular conditions.

Related Terms

1. Glaucoma: A broader term that encompasses various types of glaucoma, including both open-angle and angle-closure forms.
2. Intraocular Pressure (IOP): A key measurement in diagnosing and managing glaucoma, as elevated IOP is a common feature of this condition.
3. Angle-Closure Glaucoma: This term refers to both acute and chronic forms of angle-closure glaucoma, emphasizing the mechanism of angle closure.
4. Visual Field Loss: A common consequence of untreated chronic angle-closure glaucoma, referring to the loss of peripheral vision.
5. Ocular Hypertension: A condition often associated with glaucoma, where the intraocular pressure is higher than normal, potentially leading to damage to the optic nerve.

Conclusion

Understanding the alternative names and related terms for chronic angle-closure glaucoma (ICD-10 code H40.22) is essential for accurate diagnosis, treatment, and communication among healthcare professionals. These terms not only facilitate better understanding among practitioners but also enhance patient education regarding their condition. If you have further questions or need more specific information, feel free to ask!

Chronic angle-closure glaucoma, classified under the ICD-10 code H40.22, is a specific type of glaucoma characterized by a gradual closure of the anterior chamber angle, leading to increased intraocular pressure (IOP) and potential damage to the optic nerve. The diagnosis of chronic angle-closure glaucoma involves several criteria, which can be categorized into clinical findings, diagnostic tests, and patient history.

Clinical Findings

1. Intraocular Pressure (IOP):
   - Patients typically present with elevated IOP, often exceeding 21 mmHg. Chronic angle-closure glaucoma may show consistently high IOP readings during examinations[1].

2. Visual Field Loss:
   - Assessment of visual fields may reveal peripheral vision loss, which is indicative of optic nerve damage due to prolonged elevated IOP. This loss can be detected through standard perimetry tests[2].

3. Optic Nerve Assessment:
   - Examination of the optic nerve head may show cupping or pallor, which are signs of glaucomatous damage. The optic nerve's appearance is crucial in confirming the diagnosis[3].

4. Anterior Chamber Angle Examination:
   - Gonioscopy is performed to evaluate the anterior chamber angle. In chronic angle-closure glaucoma, the angle is often found to be narrow or closed, which is a key diagnostic criterion[4].

Diagnostic Tests

1. Tonometry:
   - This test measures the IOP. Elevated IOP is a significant indicator of glaucoma, and repeated measurements may be necessary to confirm chronic elevation[5].

2. Pachymetry:
   - Measuring corneal thickness can provide additional information, as thinner corneas may be associated with a higher risk of glaucoma progression[6].

3. Visual Field Testing:
   - Regular visual field tests help monitor the extent of vision loss and are essential for diagnosing and managing glaucoma[7].

4. Optical Coherence Tomography (OCT):
   - OCT can be used to assess the retinal nerve fiber layer and ganglion cell layer, providing detailed images that help in evaluating the extent of optic nerve damage[8].

Patient History

1. Symptoms:
   - Patients may report symptoms such as blurred vision, halos around lights, or eye pain, particularly during acute episodes. However, chronic angle-closure glaucoma may be asymptomatic until significant damage has occurred[9].

2. Family History:
   - A family history of glaucoma can increase the likelihood of developing the condition, making it an important aspect of the patient’s medical history[10].

3. Previous Eye Conditions:
   - History of other eye conditions, such as cataracts or previous eye surgeries, may contribute to the risk of developing angle-closure glaucoma[11].

Conclusion

The diagnosis of chronic angle-closure glaucoma (ICD-10 code H40.22) relies on a combination of clinical findings, diagnostic tests, and patient history. Elevated intraocular pressure, visual field loss, and a narrow or closed anterior chamber angle are critical indicators. Regular monitoring and comprehensive eye examinations are essential for early detection and management of this condition to prevent irreversible vision loss. If you suspect chronic angle-closure glaucoma, it is crucial to consult an eye care professional for a thorough evaluation and appropriate management.

Chronic angle-closure glaucoma, classified under ICD-10 code H40.22, is a serious condition that requires careful management to prevent vision loss. This type of glaucoma occurs when the drainage angle of the eye becomes blocked, leading to increased intraocular pressure (IOP). Here’s a detailed overview of the standard treatment approaches for this condition.

Understanding Chronic Angle-Closure Glaucoma

Chronic angle-closure glaucoma is characterized by a gradual closure of the anterior chamber angle, which can lead to elevated IOP and optic nerve damage over time. Unlike acute angle-closure glaucoma, which presents suddenly with severe symptoms, chronic angle-closure may develop insidiously, often without noticeable symptoms until significant damage has occurred[1].

Treatment Approaches

1. Medical Management

The first line of treatment typically involves medications aimed at lowering intraocular pressure. Common classes of medications include:

• Prostaglandin Analogues: These increase the outflow of aqueous humor, thereby reducing IOP. Examples include latanoprost and bimatoprost.
• Beta-Blockers: These decrease aqueous humor production. Timolol is a widely used beta-blocker in glaucoma management.
• Alpha Agonists: Medications like brimonidine can also reduce IOP by decreasing aqueous humor production and increasing outflow.
• Carbonic Anhydrase Inhibitors: These can be used topically (e.g., dorzolamide) or orally (e.g., acetazolamide) to reduce aqueous humor production[2][3].

2. Laser Therapy

When medical management is insufficient, laser procedures may be indicated:

• Laser Peripheral Iridotomy (LPI): This is the most common surgical intervention for angle-closure glaucoma. It involves creating a small hole in the peripheral iris to allow aqueous humor to flow freely, thereby relieving pressure in the eye.
• Laser Iridoplasty: This procedure is used in cases where LPI is not feasible. It involves applying laser energy to the peripheral iris to help open the angle[4].

3. Surgical Options

In cases where laser therapy does not adequately control IOP, surgical options may be considered:

• Trabeculectomy: This surgical procedure creates a new drainage pathway for aqueous humor, effectively lowering IOP. It is often reserved for more advanced cases or when other treatments fail.
• Glaucoma Drainage Devices: These devices can be implanted to facilitate aqueous humor drainage, particularly in patients with complex glaucoma or those who have had previous surgeries[5].

4. Monitoring and Follow-Up

Regular follow-up is crucial for patients with chronic angle-closure glaucoma. Monitoring IOP, visual field testing, and optic nerve assessment are essential components of ongoing care. Adjustments to treatment may be necessary based on the patient's response and any progression of the disease[6].

Conclusion

Chronic angle-closure glaucoma is a progressive condition that necessitates a multifaceted treatment approach, including medical therapy, laser interventions, and potentially surgical options. Early diagnosis and intervention are critical to preserving vision and preventing complications. Regular monitoring and individualized treatment plans are essential for effective management of this condition. If you suspect you or someone you know may be experiencing symptoms of glaucoma, it is vital to seek professional medical advice promptly.