ICD-10: H40.222

Chronic angle-closure glaucoma is a specific type of glaucoma characterized by the gradual closure of the drainage angle in the eye, leading to increased intraocular pressure (IOP) and potential damage to the optic nerve. The ICD-10-CM code H40.222 specifically refers to this condition in the left eye.

Clinical Description

Definition

Chronic angle-closure glaucoma occurs when the peripheral iris blocks the trabecular meshwork, which is responsible for draining aqueous humor from the eye. This blockage 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[1].

Symptoms

Patients with chronic angle-closure glaucoma may experience:
- Visual disturbances: Blurred vision or halos around lights.
- Eye pain: Often mild but can become more pronounced.
- Headaches: Particularly in the area 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.
- Ethnicity: Certain populations, such as those of Asian descent, have a higher prevalence.
- Family history: A genetic predisposition can play a role.
- Other eye conditions: Conditions like cataracts or a shallow anterior chamber can contribute to the risk.

Diagnosis

Diagnosis of chronic angle-closure glaucoma typically involves:
- Comprehensive eye examination: Including visual acuity tests and a thorough assessment of the optic nerve.
- Tonometry: To measure intraocular pressure.
- Gonioscopy: This procedure allows the eye care professional to examine the drainage angle directly and assess its openness.
- Visual field testing: To evaluate any loss of peripheral vision.

Treatment

Management of chronic angle-closure glaucoma may include:
- Medications: To lower IOP, including topical beta-blockers, prostaglandin analogs, and carbonic anhydrase inhibitors.
- Laser therapy: Procedures such as laser peripheral iridotomy can create a new drainage pathway for aqueous humor, relieving pressure.
- Surgical options: In some cases, surgical intervention may be necessary to improve drainage and reduce IOP.

Conclusion

Chronic angle-closure glaucoma, particularly when specified for the left eye under ICD-10 code H40.222, is a serious condition that requires timely diagnosis and management to prevent irreversible vision loss. Regular eye examinations and awareness of risk factors are crucial for early detection and effective treatment. If you suspect symptoms or have risk factors, consulting an eye care professional is essential for appropriate evaluation and intervention[2][3].

Chronic angle-closure glaucoma (H40.222) is a specific type of glaucoma characterized by a gradual and progressive closure of the anterior chamber angle, leading to increased intraocular pressure (IOP) and potential optic nerve damage. 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, which can make it challenging to diagnose in its early stages. Patients may not experience acute symptoms initially, but as the condition progresses, they may present with various clinical features.

Signs and Symptoms

1. Increased Intraocular Pressure (IOP):
   - Patients may exhibit elevated IOP, which is a hallmark of glaucoma. Chronic angle-closure glaucoma typically presents with IOP readings above the normal range (10-21 mmHg) but can be significantly higher in advanced cases[1].

2. Visual Symptoms:
   - Patients may report blurred vision or a gradual loss of peripheral vision. In some cases, they may experience halos around lights, particularly in low-light conditions[1][2].

3. Eye Discomfort:
   - Patients often describe a sensation of pressure or discomfort in the affected eye. This discomfort can be persistent and may worsen with time[2].

4. Redness of the Eye:
   - The affected eye may appear red due to conjunctival injection, which can be a sign of increased IOP or inflammation[1].

5. Corneal Edema:
   - In advanced cases, corneal edema may occur, leading to a cloudy appearance of the cornea, which can further impair vision[2].

6. Optic Nerve Changes:
   - Fundoscopic examination may reveal optic nerve head changes, such as cupping, which indicates damage to the optic nerve due to prolonged elevated IOP[1].

Patient Characteristics

Chronic angle-closure glaucoma is more prevalent in certain demographic groups, and understanding these characteristics can aid in identifying at-risk patients:

1. Age:
   - The condition is more common in older adults, particularly those over the age of 60, as the anatomical changes in the eye that predispose individuals to angle closure become more pronounced with age[2].

2. Gender:
   - Women are at a higher risk compared to men, possibly due to anatomical differences in the eye and hormonal factors[1].

3. Ethnicity:
   - Certain ethnic groups, particularly individuals of Asian descent, have a higher prevalence of angle-closure glaucoma due to anatomical variations in the anterior chamber[2].

4. Family History:
   - A family history of glaucoma can increase the risk of developing chronic angle-closure glaucoma, indicating a genetic predisposition[1].

5. Other Medical Conditions:
   - Conditions such as hyperopia (farsightedness) can increase the risk of angle-closure due to the shallower anterior chamber associated with this refractive error[2].

Conclusion

Chronic angle-closure glaucoma (H40.222) is a serious condition that requires prompt recognition and management to prevent irreversible vision loss. Understanding its clinical presentation, including the signs and symptoms, as well as the characteristics of affected patients, is essential for healthcare providers. Regular eye examinations, especially for at-risk populations, can facilitate early detection and treatment, ultimately preserving vision and improving quality of life for those affected.

Chronic angle-closure glaucoma, specifically coded as H40.222 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.

Alternative Names for H40.222

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 condition.
3. Chronic Angle-Closure Glaucoma: A slight variation that omits the specification of "left eye" but retains the essential characteristics of the condition.
4. Left Eye Angle-Closure Glaucoma: This term specifies the affected eye while maintaining the focus on angle-closure glaucoma.

Related Terms

1. Intraocular Pressure (IOP): A critical measurement in diagnosing and managing glaucoma, as elevated IOP is a common feature of this condition.
2. Visual Field Loss: A potential consequence of untreated chronic angle-closure glaucoma, referring to the loss of peripheral vision.
3. 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.
4. Glaucoma Suspect: A term used for patients who may be at risk for developing glaucoma, including those with narrow angles.
5. Gonioscopy: A diagnostic procedure used to examine the angle of the anterior chamber of the eye, crucial for diagnosing angle-closure glaucoma.

Conclusion

Understanding the alternative names and related terms for ICD-10 code H40.222 is essential for healthcare professionals involved in the diagnosis and treatment of glaucoma. These terms not only facilitate clearer communication among medical staff but also enhance patient education regarding their condition. Proper documentation using these terms can improve the accuracy of medical records and billing processes, ensuring that patients receive appropriate care and follow-up.

Chronic angle-closure glaucoma is a specific type of glaucoma characterized by the gradual closure of the drainage angle in the eye, leading to increased intraocular pressure (IOP) and potential damage to the optic nerve. The ICD-10 code H40.222 specifically refers to chronic angle-closure glaucoma in the left eye. The diagnosis of this condition involves several criteria and clinical assessments.

Diagnostic Criteria for Chronic Angle-Closure Glaucoma

1. Clinical Symptoms

Patients may present with various symptoms that can indicate chronic angle-closure glaucoma, including:
- Visual Disturbances: Blurred vision or halos around lights.
- Eye Pain: Discomfort or pain in the affected eye.
- Headaches: Frequent headaches, particularly around the eyes.
- Nausea and Vomiting: These symptoms may occur during acute episodes but can also be present in chronic cases.

2. Intraocular Pressure Measurement

• Elevated IOP: A key diagnostic criterion is the measurement of intraocular pressure. Chronic angle-closure glaucoma typically presents with elevated IOP, often above 21 mmHg, although this can vary based on individual circumstances.

3. 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 narrow or closed, which can be confirmed through this examination.

4. Optic Nerve Assessment

• Optic Nerve Damage: Evaluation of the optic nerve head for signs of damage is essential. This may include looking for:
• Optic Nerve Cupping: Increased cupping of the optic disc can indicate glaucomatous damage.
• Visual Field Testing: Perimetry tests may reveal characteristic visual field defects associated with glaucoma.

5. History and Risk Factors

• Patient History: A thorough medical history is important, including any previous episodes of acute angle-closure glaucoma, family history of glaucoma, and other risk factors such as age, ethnicity, and systemic conditions (e.g., diabetes).

6. Additional Diagnostic Tests

• Pachymetry: Measurement of corneal thickness can provide additional information, as thinner corneas may be associated with a higher risk of glaucoma.
• Imaging Studies: Optical coherence tomography (OCT) may be used to assess the retinal nerve fiber layer and provide further evidence of optic nerve damage.

Conclusion

The diagnosis of chronic angle-closure glaucoma (ICD-10 code H40.222) involves a comprehensive evaluation that includes clinical symptoms, intraocular pressure measurements, gonioscopy, optic nerve assessment, and consideration of patient history and risk factors. Accurate diagnosis is crucial for effective management and treatment to prevent vision loss associated with this condition. Regular monitoring and follow-up are essential for patients diagnosed with this type of glaucoma to manage intraocular pressure and preserve visual function.

Chronic angle-closure glaucoma (ICD-10 code H40.222) is a serious eye condition characterized by increased intraocular pressure due to the closure of the drainage angle in the eye. This condition can lead to optic nerve damage and vision loss if not treated promptly. The management of chronic angle-closure glaucoma typically involves a combination of medical, laser, and surgical interventions. Below is a detailed overview of the standard treatment approaches.

Medical Management

1. Medications

• Topical Medications: The first line of treatment often includes topical medications to lower intraocular pressure (IOP). Common classes of medications include:
  • Prostaglandin analogs (e.g., latanoprost, bimatoprost) which increase aqueous humor outflow.
  • Beta-blockers (e.g., timolol) that reduce aqueous humor production.
  • Alpha agonists (e.g., brimonidine) that decrease aqueous humor production and increase outflow.
  • Carbonic anhydrase inhibitors (e.g., dorzolamide) that also reduce aqueous humor production.
• Oral Medications: In some cases, oral carbonic anhydrase inhibitors (e.g., acetazolamide) may be prescribed to further reduce IOP, especially in acute settings.

2. Monitoring

• Regular monitoring of IOP and visual field testing is essential to assess the effectiveness of the treatment and to make necessary adjustments.

Laser Treatment

1. Laser Peripheral Iridotomy (LPI)

• LPI is a common and effective procedure for treating angle-closure glaucoma. It involves creating a small hole in the peripheral iris using a laser, which allows aqueous humor to flow from the posterior to the anterior chamber, thereby relieving the pressure in the eye. This procedure is often performed as an outpatient procedure and can be crucial in preventing acute attacks.

2. Laser Iridoplasty

• In cases where LPI is not feasible, laser iridoplasty may be performed. This technique uses laser energy to stretch the peripheral iris, helping to open the angle.

Surgical Interventions

1. Surgical Options

• If medical and laser treatments are insufficient, surgical options may be considered. These include:
  • Trabeculectomy: A surgical procedure that creates a new drainage pathway for aqueous humor, effectively lowering IOP.
  • Tube Shunt Surgery: Involves implanting a tube to facilitate aqueous humor drainage, particularly in cases where trabeculectomy is not successful or feasible.

2. Cataract Surgery

• If the patient also has cataracts, cataract surgery may be performed, as it can help improve the angle and reduce IOP. This is particularly relevant in patients with coexisting cataracts and angle-closure glaucoma.

Conclusion

The management of chronic angle-closure glaucoma (ICD-10 code H40.222) requires a comprehensive approach tailored to the individual patient's needs. Initial treatment typically involves medications to control IOP, followed by laser procedures such as LPI or iridoplasty. In cases where these methods are insufficient, surgical interventions may be necessary. Regular follow-up and monitoring are crucial to ensure effective management and to prevent vision loss. Early intervention is key to preserving vision and maintaining quality of life for patients with this condition.