ICD-10: H40.223

Chronic angle-closure glaucoma is a significant ocular condition characterized by the gradual closure of the anterior chamber angle, leading to increased intraocular pressure (IOP) and potential damage to the optic nerve. The ICD-10 code for this condition is H40.223, specifically denoting bilateral involvement.

Clinical Description

Definition

Chronic angle-closure glaucoma occurs when the drainage angle of the eye becomes obstructed, preventing aqueous humor from exiting the eye. This obstruction can lead to a gradual increase in IOP, which may not present with acute symptoms initially but can result in irreversible optic nerve damage over time if left untreated[1].

Symptoms

Patients with chronic angle-closure glaucoma may experience:
- Visual disturbances: Blurred vision or halos around lights.
- Eye discomfort: A feeling of pressure or heaviness in the eyes.
- Headaches: Often localized around the eyes.
- Nausea and vomiting: In some cases, particularly if the condition progresses to an acute attack.

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 can contribute to angle closure.

Diagnosis

Diagnosis of chronic angle-closure glaucoma typically involves:
- Comprehensive eye examination: Including visual acuity tests, tonometry to measure IOP, and gonioscopy to assess the angle of the anterior chamber.
- Optic nerve assessment: Using imaging techniques to evaluate any damage to the optic nerve.

Treatment

Management of chronic angle-closure glaucoma may include:
- Medications: To lower IOP, such as topical beta-blockers, prostaglandin analogs, or carbonic anhydrase inhibitors.
- Laser therapy: Procedures like laser peripheral iridotomy or laser iridoplasty can create a new drainage pathway for aqueous humor.
- Surgical intervention: In severe cases, surgical options may be necessary to relieve pressure and prevent further optic nerve damage.

Coding and Documentation

The ICD-10 code H40.223 specifically indicates chronic angle-closure glaucoma that is bilateral, meaning it affects both eyes. Accurate documentation is crucial for proper coding and billing, ensuring that the condition is clearly described in medical records to facilitate appropriate treatment and reimbursement processes[2][3].

In summary, chronic angle-closure glaucoma is a serious condition that requires timely diagnosis and management to prevent vision loss. Understanding its clinical features, risk factors, and treatment options is essential for healthcare providers in delivering effective care to affected patients.

Chronic angle-closure glaucoma (CACG) is a significant ocular condition characterized by the gradual closure of the anterior chamber angle, leading to increased intraocular pressure (IOP) and potential optic nerve damage. The ICD-10 code H40.223 specifically refers to bilateral chronic angle-closure glaucoma. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management.

Clinical Presentation

Signs

1. Increased Intraocular Pressure (IOP): Patients often present with elevated IOP, which can be measured during a comprehensive eye examination. Normal IOP ranges from 10 to 21 mmHg, and values above this threshold may indicate glaucoma[1].
2. Optic Nerve Changes: Examination may reveal optic nerve head cupping, which is indicative of glaucomatous damage. This can be assessed through fundoscopic examination[2].
3. Visual Field Defects: Patients may exhibit characteristic visual field loss, often starting with peripheral vision impairment. Automated perimetry can help in identifying these defects[3].

Symptoms

1. Visual Disturbances: Patients may report blurred vision, particularly in low-light conditions, due to the progressive nature of the disease affecting the retina and optic nerve[4].
2. Halos Around Lights: A common symptom is the perception of halos around lights, which occurs due to corneal edema and changes in the eye's refractive properties[5].
3. Eye Pain or Discomfort: Chronic angle-closure glaucoma can lead to persistent eye discomfort or pain, which may be exacerbated by increased IOP[6].
4. Headaches: Patients may experience headaches, particularly in the frontal region, which can be attributed to the ocular pressure and associated discomfort[7].

Patient Characteristics

Demographics

• Age: Chronic angle-closure glaucoma is more prevalent in older adults, particularly those over the age of 60, as the risk of developing this condition increases with age[8].
• Gender: There is a higher incidence in females compared to males, possibly due to anatomical differences in the eye structure and hormonal factors[9].
• Ethnicity: Certain ethnic groups, particularly those of Asian descent, are at a higher risk for developing angle-closure glaucoma due to anatomical predispositions such as a shallower anterior chamber[10].

Medical History

• Family History: A family history of glaucoma can increase the risk of developing chronic angle-closure glaucoma, indicating a genetic predisposition[11].
• Previous Eye Conditions: Patients with a history of other eye conditions, such as cataracts or previous eye surgeries, may be at increased risk[12].
• Systemic Conditions: Conditions such as diabetes and hypertension can also contribute to the risk of developing glaucoma, including chronic angle-closure types[13].

Conclusion

Chronic angle-closure glaucoma, classified under ICD-10 code H40.223, presents with a range of clinical signs and symptoms that can significantly impact a patient's quality of life. Early detection through regular eye examinations is essential, especially for at-risk populations, to prevent irreversible vision loss. Understanding the demographic and clinical characteristics associated with this condition can aid healthcare providers in identifying and managing patients effectively. Regular monitoring and appropriate treatment strategies are crucial in managing intraocular pressure and preserving vision in affected individuals.

Chronic angle-closure glaucoma, bilateral, is classified under the ICD-10 code H40.223. This specific condition is characterized by a gradual closure of the drainage angle in the eye, 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. Bilateral Chronic Closed-Angle Glaucoma: This term emphasizes the bilateral nature of the condition and the chronic aspect of the angle closure.
2. Bilateral Angle-Closure Glaucoma: A more straightforward term that highlights the angle-closure mechanism affecting both eyes.
3. Chronic Bilateral Glaucoma: While this term is broader, it can refer to chronic glaucoma cases that may include angle-closure types.
4. Chronic Narrow-Angle Glaucoma: This term focuses on the narrow angle characteristic of the condition, which is a key feature in angle-closure glaucoma.

Related Terms

1. Intraocular Pressure (IOP): Refers to the fluid pressure inside the eye, which is often elevated in glaucoma cases, including chronic angle-closure glaucoma.
2. Visual Field Loss: A common consequence of untreated glaucoma, where peripheral vision may be affected.
3. Pupillary Block: A mechanism often involved in angle-closure glaucoma, where the iris blocks the flow of aqueous humor, leading to increased pressure.
4. Glaucomatous Optic Neuropathy: A term that describes the optic nerve damage that can occur due to prolonged elevated intraocular pressure.
5. Acute Angle-Closure Glaucoma: While distinct from chronic angle-closure glaucoma, it is related and can occur suddenly, requiring immediate medical attention.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals when diagnosing, coding, and discussing the condition with patients or colleagues. Accurate terminology ensures effective communication and appropriate management of the disease, which can significantly impact patient outcomes.

In summary, the ICD-10 code H40.223 for chronic angle-closure glaucoma, bilateral, is associated with various alternative names and related terms that reflect its clinical characteristics and implications. Familiarity with these terms can aid in better understanding and managing this serious ocular condition.

Chronic angle-closure glaucoma, bilateral, is classified under the ICD-10-CM code H40.223. The diagnosis of this condition involves a combination of clinical findings, patient history, and specific criteria. Below is a detailed overview of the criteria used for diagnosing this condition.

Clinical Criteria for Diagnosis

1. Intraocular Pressure (IOP) Measurement

• Elevated IOP: A key indicator of glaucoma is elevated intraocular pressure, typically above 21 mmHg. In chronic angle-closure glaucoma, IOP may be significantly higher due to the obstruction of aqueous humor outflow.

2. Gonioscopy Findings

• Angle Closure: Gonioscopy is essential for visualizing the anterior chamber angle. In chronic angle-closure glaucoma, the angle is typically closed or very narrow, indicating that the drainage system is obstructed.
• Structural Changes: The presence of structural changes in the angle, such as synechiae (adhesions), may also be noted.

3. Visual Field Testing

• Visual Field Defects: Patients may exhibit characteristic visual field defects, often peripheral vision loss, which is indicative of glaucomatous damage. These defects can be assessed through perimetry tests.

4. Optic Nerve Assessment

• Optic Nerve Head Changes: Examination of the optic nerve head may reveal cupping or other changes consistent with glaucoma. This can be assessed through direct ophthalmoscopy or imaging techniques.

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.

Additional Considerations

1. History of Angle Closure

• A history of intermittent angle closure or previous episodes of acute angle-closure glaucoma can support the diagnosis of chronic angle-closure glaucoma.

2. Risk Factors

• Demographics: Certain populations, particularly older adults and individuals of Asian descent, are at higher risk for developing angle-closure glaucoma.
• Family History: A family history of glaucoma can also be a contributing factor.

3. Exclusion of Other Conditions

• It is crucial to rule out other types of glaucoma or ocular conditions that may mimic the symptoms or findings of chronic angle-closure glaucoma.

Conclusion

The diagnosis of chronic angle-closure glaucoma, bilateral (ICD-10 code H40.223), relies on a comprehensive evaluation that includes measuring intraocular pressure, gonioscopy, visual field testing, and optic nerve assessment, along with a thorough patient history. Proper diagnosis is essential for effective management and treatment to prevent further vision loss. If you suspect this condition, it is advisable to consult an ophthalmologist for a detailed examination and appropriate intervention.

Chronic angle-closure glaucoma (ICD-10 code H40.223) 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 the 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 are typically the first-line treatment for lowering IOP. They work by increasing the outflow of aqueous humor. Examples include latanoprost and bimatoprost.
• Beta-blockers: These reduce aqueous humor production. Timolol is a commonly used beta-blocker.
• Alpha agonists: These can both decrease aqueous humor production and increase outflow. Brimonidine is an example.
• Carbonic anhydrase inhibitors: These medications, such as dorzolamide, also reduce aqueous humor production.
• Oral carbonic anhydrase inhibitors: In more severe cases, medications like acetazolamide may be prescribed to provide additional IOP reduction.

2. Topical Hyperosmotic Agents

In acute situations, hyperosmotic agents like mannitol may be used to rapidly decrease IOP by drawing fluid out of the eye.

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 freely from the posterior to the anterior chamber, thereby relieving pressure. This procedure is often performed as an outpatient treatment 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 shrink the peripheral iris, widening the angle and improving aqueous outflow.

Surgical Interventions

1. Goniotomy or Trabeculotomy

These surgical procedures involve incising the trabecular meshwork to improve aqueous outflow. They are typically considered when laser treatments are insufficient.

2. Aqueous Shunts or Stents

In more advanced cases, surgical implantation of aqueous shunts or stents may be necessary to facilitate drainage of aqueous humor and lower IOP effectively.

3. Trabeculectomy

This surgical procedure creates a new drainage pathway for aqueous humor, effectively lowering IOP. It is often reserved for cases that do not respond to other treatments.

Follow-Up and Monitoring

Regular follow-up appointments are essential for monitoring IOP and assessing the effectiveness of the treatment plan. Adjustments to medications or additional interventions may be necessary based on the patient's response.

Conclusion

Chronic angle-closure glaucoma (H40.223) requires a comprehensive treatment approach that may include medications, laser procedures, and surgical interventions. Early diagnosis and timely management are crucial to prevent irreversible vision loss. Patients should work closely with their ophthalmologists to determine the most appropriate treatment strategy tailored to their specific condition and needs. Regular monitoring and follow-up care are vital to ensure optimal outcomes and manage any potential complications effectively.