ICD-10: H40.221

Chronic angle-closure glaucoma, specifically coded as H40.221 in the ICD-10 classification, 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 alternative names and related terms associated with this condition.

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 key feature of the disease.
3. Chronic Angle-Closure Glaucoma: A slight variation that omits the "right eye" specification but retains the essential characteristics of the condition.

Related Terms

1. Glaucoma: A broader term that encompasses various types of glaucoma, including open-angle and angle-closure types.
2. Intraocular Pressure (IOP): A critical measurement in diagnosing and managing glaucoma, as elevated IOP is a common feature of this condition.
3. Visual Field Loss: A potential consequence of untreated chronic angle-closure glaucoma, referring to the loss of peripheral vision.
4. Ocular Hypertension: A condition where the intraocular pressure is higher than normal, which can lead to glaucoma if not managed.
5. Acute Angle-Closure Glaucoma: While distinct from chronic angle-closure glaucoma, this term is related as it describes a sudden and severe increase in intraocular pressure due to angle closure.

Clinical Context

In clinical practice, it is essential to differentiate between chronic and acute forms of angle-closure glaucoma, as their management strategies may differ significantly. Chronic angle-closure glaucoma often develops slowly and may not present with immediate symptoms, whereas acute angle-closure glaucoma can lead to sudden vision loss and requires urgent treatment.

Understanding these alternative names and related terms can facilitate better communication among healthcare providers and improve patient education regarding the condition and its implications.

Chronic angle-closure glaucoma is a specific type of glaucoma characterized by the gradual closure of the anterior chamber angle, which can lead to increased intraocular pressure (IOP) and potential damage to the optic nerve. The ICD-10 code H40.221 specifically refers to this condition affecting the right eye.

Clinical Description

Definition

Chronic angle-closure glaucoma occurs when the drainage angle of the eye becomes obstructed, preventing aqueous humor from properly exiting the eye. This obstruction can lead to a gradual increase in IOP, which may not present immediate symptoms but can result in significant vision loss over time if left untreated.

Symptoms

Patients with chronic angle-closure glaucoma may experience:
- Visual disturbances: Blurred vision or halos around lights.
- Eye pain: Often mild but can become severe.
- Headaches: Particularly around the eyes.
- Nausea and vomiting: In some cases, these symptoms may accompany acute episodes.
- Gradual loss of peripheral vision: This can progress unnoticed until significant damage has occurred.

Risk Factors

Several factors can increase the risk of developing chronic angle-closure glaucoma, including:
- Age: Older adults are at higher risk.
- Gender: Women are more frequently affected than men.
- Ethnicity: Certain populations, such as those of Asian descent, have a higher prevalence.
- Family history: A genetic predisposition may play a role.

Diagnosis

Clinical Examination

Diagnosis typically involves a comprehensive eye examination, which may include:
- Tonometry: To measure IOP.
- Gonioscopy: To assess the angle of the anterior chamber.
- Visual field testing: To evaluate peripheral vision loss.
- Optic nerve assessment: To check for damage indicative of glaucoma.

Imaging

Advanced imaging techniques, such as optical coherence tomography (OCT), may be used to visualize the optic nerve and retinal nerve fiber layer, providing further insight into the extent of damage.

Treatment Options

Medical Management

Initial treatment often involves medications to lower IOP, including:
- Prostaglandin analogs: To increase aqueous humor outflow.
- Beta-blockers: To reduce aqueous humor production.
- Alpha agonists and carbonic anhydrase inhibitors: As adjunct therapies.

Surgical Interventions

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

Prognosis

The prognosis for patients with chronic angle-closure glaucoma largely depends on early detection and treatment. If managed appropriately, many patients can maintain their vision and quality of life. However, untreated chronic angle-closure glaucoma can lead to irreversible vision loss.

In summary, chronic angle-closure glaucoma (ICD-10 code H40.221) is a serious condition that requires timely diagnosis and intervention to prevent significant visual impairment. Regular eye examinations are crucial for at-risk populations to ensure early detection and management of this potentially debilitating disease.

Chronic angle-closure glaucoma (ICD-10 code H40.221) is a significant ocular condition characterized by a gradual and progressive increase in intraocular pressure (IOP) due to the obstruction of aqueous humor outflow. This condition primarily affects the anterior chamber angle of the eye, leading to various clinical presentations, signs, symptoms, and patient characteristics.

Clinical Presentation

Chronic angle-closure glaucoma often develops insidiously, which can make early detection challenging. Patients may not experience acute symptoms initially, but as the disease progresses, they may present with a range of ocular and systemic signs.

Signs and Symptoms

1. Visual Disturbances:
   - Patients may report blurred vision, particularly in low-light conditions, due to corneal edema or lens opacities.
   - Halos around lights are common, especially at night, as the pupil dilates and the angle narrows further.

2. Ocular Pain:
   - While chronic cases may not present with severe pain, patients can experience intermittent discomfort or pressure in the affected eye.
   - Some may report headaches or brow pain, which can be mistaken for tension headaches.

3. Intraocular Pressure (IOP):
   - Chronic angle-closure glaucoma is associated with elevated IOP, often exceeding 21 mmHg, which can be measured during a comprehensive eye examination.

4. Pupil Changes:
   - The affected eye may exhibit a mid-dilated, non-reactive pupil due to iris ischemia or damage to the iris sphincter.

5. Corneal Changes:
   - Corneal edema may occur, leading to a cloudy appearance of the cornea, which can further impair vision.

6. Optic Nerve Damage:
   - Progressive damage to the optic nerve can lead to characteristic changes in the optic disc, such as cupping, which is indicative of glaucomatous damage.

Patient Characteristics

1. Demographics:
   - Chronic angle-closure glaucoma is more prevalent in older adults, particularly those over the age of 60.
   - It is more common in women than men, possibly due to anatomical differences in the anterior chamber angle.

2. Ethnicity:
   - Certain ethnic groups, particularly individuals of Asian descent, are at a higher risk for developing angle-closure glaucoma due to anatomical predispositions.

3. Family History:
   - A family history of glaucoma can increase the risk of developing chronic angle-closure glaucoma, indicating a genetic component to the disease.

4. Pre-existing Conditions:
   - Patients with hyperopia (farsightedness) are at a greater risk due to the shallower anterior chamber, which can predispose them to angle closure.
   - Other risk factors include a history of cataract surgery, which can alter the anatomy of the eye and increase the likelihood of angle closure.

5. Systemic Conditions:
   - Conditions such as diabetes and hypertension may also be associated with an increased risk of glaucoma, including chronic angle-closure types.

Conclusion

Chronic angle-closure glaucoma (H40.221) is a complex condition that requires careful monitoring and management to prevent irreversible vision loss. Understanding the clinical presentation, signs, symptoms, and patient characteristics is crucial for early diagnosis and effective treatment. Regular eye examinations, particularly for at-risk populations, are essential for detecting this condition before significant damage occurs. Early intervention can significantly improve patient outcomes and preserve vision.

Chronic angle-closure glaucoma, classified under the ICD-10 code H40.221, 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 this condition involves several criteria and clinical assessments.

Diagnostic Criteria for Chronic Angle-Closure Glaucoma

1. Intraocular Pressure Measurement

• Elevated IOP: A key indicator of glaucoma is elevated intraocular pressure, typically above 21 mmHg. In chronic angle-closure glaucoma, IOP may be consistently high due to the obstruction of aqueous humor outflow caused by the closure of the angle[1].

2. Gonioscopy

• Angle Assessment: Gonioscopy is a critical diagnostic tool that allows the clinician to visualize the anterior chamber angle. In chronic angle-closure glaucoma, the angle is often found to be narrow or closed, indicating that the drainage pathways for aqueous humor are obstructed[2].

3. Visual Field Testing

• Field Defects: Patients may exhibit characteristic visual field defects associated with glaucoma. These defects can include peripheral vision loss, which is often progressive. Standard automated perimetry is used to assess these changes[3].

4. Optic Nerve Examination

• Optic Nerve Head Changes: The examination of the optic nerve head through fundus photography or optical coherence tomography (OCT) can reveal changes such as cupping or pallor, which are indicative of glaucomatous damage[4].

5. Patient Symptoms

• 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[5].

6. History of Angle Closure

• Previous Episodes: A history of intermittent angle closure or acute angle-closure glaucoma episodes can support the diagnosis of chronic angle-closure glaucoma. This history may include episodes of eye pain, headache, nausea, or vomiting[6].

7. Other Risk Factors

• Demographics and Risk Factors: Certain demographic factors, such as age, ethnicity (higher prevalence in Asian populations), and family history of glaucoma, can increase the likelihood of developing chronic angle-closure glaucoma[7].

Conclusion

The diagnosis of chronic angle-closure glaucoma (ICD-10 code H40.221) is multifaceted, relying on a combination of clinical findings, patient history, and specific diagnostic tests. Early detection and management are crucial to prevent irreversible vision loss associated with this condition. Regular eye examinations, particularly for individuals at higher risk, are essential for timely diagnosis and intervention. If you have further questions or need more detailed information on treatment options, feel free to ask!

Chronic angle-closure glaucoma (ICD-10 code H40.221) is a serious condition characterized by the gradual closure of the drainage angle in the eye, leading to increased intraocular pressure (IOP) and potential vision loss. The management of this condition typically involves a combination of medical, laser, and surgical interventions. Below is a detailed overview of standard treatment approaches for chronic angle-closure glaucoma.

Medical Management

1. Medications

The initial approach often includes medications aimed at lowering intraocular pressure. Common classes of medications include:

• Prostaglandin analogs: 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 frequently used option.
• Alpha agonists: These also reduce aqueous humor production and increase outflow. Brimonidine is a common choice.
• Carbonic anhydrase inhibitors: Medications like dorzolamide can help lower IOP by reducing the production of aqueous humor.
• Oral carbonic anhydrase inhibitors: In more severe cases, medications such as acetazolamide may be prescribed to provide additional IOP control.

2. Topical Therapies

Topical medications are often the first line of treatment. They are typically administered multiple times a day and can be combined for enhanced efficacy.

Laser Treatment

1. Laser Peripheral Iridotomy (LPI)

Laser peripheral iridotomy is a common and effective procedure for treating chronic 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. This procedure is often performed as an outpatient treatment and can significantly improve the drainage angle.

2. Laser Iridoplasty

In cases where LPI is not feasible or effective, laser iridoplasty may be considered. This procedure uses laser energy to stretch the peripheral iris, helping to open the angle and improve aqueous outflow.

Surgical Interventions

1. Surgical Goniosynechialysis

For patients with significant angle closure and synechiae (adhesions between the iris and the trabecular meshwork), surgical goniosynechialysis may be performed. This procedure aims to break the adhesions and restore the drainage angle.

2. Aqueous Shunts and Stents

In more advanced cases, aqueous shunts or stents may be implanted to facilitate the drainage of aqueous humor and lower IOP. These devices can be particularly useful for patients who do not respond well to other treatments.

3. Trabeculectomy

Trabeculectomy is a surgical procedure that creates a new drainage pathway for aqueous humor. It is typically reserved for patients with refractory glaucoma who do not achieve adequate control with medications or laser treatments.

Follow-Up and Monitoring

Regular follow-up appointments are crucial for monitoring IOP and assessing the effectiveness of the treatment plan. Patients may require adjustments to their medications or additional interventions based on their response to treatment.

Conclusion

Chronic angle-closure glaucoma is a complex condition that requires a multifaceted treatment approach. The combination of medical therapy, laser procedures, and surgical options allows for tailored management based on the severity of the disease and the individual patient's needs. Early diagnosis and intervention are key to preserving vision and preventing complications associated with this condition. Regular monitoring and follow-up care are essential to ensure optimal outcomes for patients diagnosed with chronic angle-closure glaucoma.