ICD-10: H40.229

Chronic angle-closure glaucoma (ICD-10 code H40.229) is a significant ocular condition characterized by a gradual and often asymptomatic increase in intraocular pressure (IOP) due to the obstruction of aqueous humor outflow. This condition can lead to irreversible optic nerve damage and vision loss if not diagnosed and managed appropriately. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Chronic angle-closure glaucoma typically presents with a gradual onset of symptoms, which can often be subtle and may go unnoticed by patients until significant damage has occurred. The condition is characterized by the following:

• Intraocular Pressure (IOP): Patients may exhibit elevated IOP, which is a hallmark of glaucoma. In chronic cases, the pressure may not spike dramatically but remains consistently elevated over time.
• Optic Nerve Damage: As the disease progresses, damage to the optic nerve can lead to visual field loss, which may be detected during a comprehensive eye examination.

Signs and Symptoms

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

• Visual Symptoms: Patients may experience peripheral vision loss, which can progress to tunnel vision. In advanced cases, central vision may also be affected.
• Eye Discomfort: Some patients report a sensation of pressure or discomfort in the eye, although this may not be prominent in chronic cases.
• Halos Around Lights: Patients may notice halos around lights, particularly in low-light conditions, due to corneal edema caused by elevated IOP.
• Redness of the Eye: There may be conjunctival injection or redness, although this is more common in acute episodes rather than chronic cases.
• Headaches: Some patients may experience headaches, particularly if the IOP is significantly elevated.

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 at a higher risk than men, possibly due to anatomical differences in the eye and hormonal factors.
• Ethnicity: Certain ethnic groups, particularly those of Asian descent, have a higher prevalence 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.
• Other Medical Conditions: Conditions such as diabetes, hypertension, and hyperopia (farsightedness) can contribute to the risk of developing this type of glaucoma.

Conclusion

Chronic angle-closure glaucoma (ICD-10 code H40.229) is a serious condition that requires early detection and management to prevent irreversible vision loss. Understanding the clinical presentation, signs, symptoms, and patient characteristics is crucial for healthcare providers to identify at-risk individuals and implement appropriate screening and treatment strategies. Regular eye examinations, particularly for high-risk populations, are essential for early diagnosis and effective management of this condition.

Chronic angle-closure glaucoma, classified under ICD-10 code H40.229, is a specific type of glaucoma characterized by the gradual closure of the angle between the iris and cornea, leading to increased intraocular pressure. Understanding alternative names and related terms for this condition can enhance clarity in medical documentation and communication. Below are some alternative names and related terms associated with H40.229.

Alternative Names

1. Chronic Closed-Angle Glaucoma: This term emphasizes the chronic nature of the condition and the closure of the angle.
2. Chronic Angle-Closure Glaucoma: A variation that maintains the focus on the chronic aspect and the angle-closure mechanism.
3. Chronic Narrow-Angle Glaucoma: This term highlights the narrowness of the angle, which is a critical factor in the pathophysiology of the disease.
4. Chronic Glaucoma with Angle Closure: A more descriptive term that indicates the presence of glaucoma along with angle closure.

Related Terms

1. Glaucoma: A general term for a group of eye conditions that damage the optic nerve, often associated with increased intraocular pressure.
2. Angle-Closure Glaucoma: A broader category that includes both acute and chronic forms of angle-closure glaucoma.
3. Intraocular Pressure (IOP): A key measurement in diagnosing and managing glaucoma, referring to the fluid pressure inside the eye.
4. Visual Field Loss: A common consequence of untreated glaucoma, where peripheral vision is affected.
5. Optic Nerve Damage: A critical concern in glaucoma, as increased pressure can lead to irreversible damage to the optic nerve.
6. Chronic Glaucoma: A term that encompasses various types of glaucoma that develop slowly over time, including angle-closure types.

Clinical Context

Chronic angle-closure glaucoma is often asymptomatic in its early stages, making regular eye examinations crucial for early detection. Patients may eventually experience symptoms such as blurred vision, halos around lights, and eye pain. The condition can lead to significant visual impairment if not managed appropriately.

In clinical settings, using precise terminology is essential for effective communication among healthcare providers and for accurate coding in medical records. Understanding the various names and related terms for H40.229 can aid in this process, ensuring that patients receive appropriate care and management for their condition.

In summary, recognizing the alternative names and related terms for chronic angle-closure glaucoma can facilitate better understanding and communication in both clinical and patient contexts.

Chronic angle-closure glaucoma is a serious eye condition that can lead to vision loss if not diagnosed and treated promptly. The ICD-10 code H40.229 specifically refers to chronic angle-closure glaucoma when the affected eye is unspecified. Understanding the diagnostic criteria for this condition is crucial for accurate coding and effective patient management.

Diagnostic Criteria for Chronic Angle-Closure Glaucoma

1. Clinical Symptoms

Patients with chronic angle-closure glaucoma may present with various symptoms, although some may be asymptomatic. Common symptoms include:
- Visual disturbances: Patients may experience blurred vision or halos around lights.
- Eye pain: This can range from mild discomfort to severe pain.
- Headaches: Often associated with eye strain or pressure.
- Nausea and vomiting: These symptoms can occur, particularly during acute episodes.

2. Intraocular Pressure (IOP) Measurement

A key diagnostic criterion is the measurement of intraocular pressure. In chronic angle-closure glaucoma, IOP is typically elevated, often exceeding 21 mmHg. Regular monitoring of IOP is essential for diagnosis and management.

3. Gonioscopy

Gonioscopy is a specialized examination that allows the clinician to visualize the anterior chamber angle. In chronic angle-closure glaucoma:
- The angle may be closed or narrowed, indicating a blockage of aqueous humor drainage.
- The presence of peripheral anterior synechiae (adhesions between the iris and the trabecular meshwork) may also be observed.

4. Optic Nerve Assessment

Assessment of the optic nerve is critical in diagnosing glaucoma. This includes:
- Optic nerve head examination: Looking for signs of damage, such as cupping or pallor.
- Visual field testing: To detect any peripheral vision loss, which is common in glaucoma patients.

5. Exclusion of Other Conditions

It is important to rule out other types of glaucoma or ocular conditions that may mimic chronic angle-closure glaucoma. This includes:
- Open-angle glaucoma
- Secondary glaucomas (e.g., due to trauma or inflammation)
- Other ocular diseases that may affect IOP or visual function.

6. Patient History

A thorough patient history is essential, including:
- Family history of glaucoma
- Previous eye surgeries or trauma
- Systemic conditions that may predispose to glaucoma, such as diabetes or hypertension.

Conclusion

The diagnosis of chronic angle-closure glaucoma (ICD-10 code H40.229) involves a combination of clinical symptoms, intraocular pressure measurements, gonioscopic examination, optic nerve assessment, and exclusion of other conditions. Accurate diagnosis is vital for effective management and to prevent potential vision loss. Regular follow-ups and monitoring are recommended for patients diagnosed with this condition to ensure timely intervention and treatment.

Chronic angle-closure glaucoma, classified under ICD-10 code H40.229, is a serious condition that requires prompt and effective 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 standard treatment approaches for this condition.

Understanding Chronic Angle-Closure Glaucoma

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

Standard Treatment Approaches

1. Medications

Initial management often includes medications aimed at lowering intraocular pressure. Common classes of medications include:

• Prostaglandin Analogues: These increase the outflow of aqueous humor and are often the first line of treatment. Examples include latanoprost and bimatoprost.
• Beta-Blockers: These reduce aqueous humor production. Timolol is a commonly used beta-blocker.
• Alpha Agonists: These also decrease aqueous humor production and increase outflow. Brimonidine is an example.
• Carbonic Anhydrase Inhibitors: Medications like dorzolamide can help reduce IOP by decreasing fluid production.
• Rho Kinase Inhibitors: A newer class that increases outflow of aqueous humor, such as netarsudil.

These medications can be used alone or in combination to achieve optimal IOP control[1][2].

2. Laser Therapy

When medications are insufficient to control IOP, 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 bypass the blocked angle, thus reducing IOP.
• Laser Iridoplasty: This procedure is used to stretch the peripheral iris and open the angle, particularly in cases where LPI is not feasible.

Both procedures aim to restore normal drainage of aqueous humor and lower IOP effectively[3][4].

3. Surgical Interventions

In cases where laser therapy is not sufficient or if there is significant structural damage, surgical options may be considered:

• Trabeculectomy: This surgery creates a new drainage pathway for aqueous humor, effectively lowering IOP. It is often reserved for more advanced cases or when other treatments fail.
• Tube Shunt Surgery: Involves implanting a device to facilitate fluid drainage from the eye, which can be particularly useful in complex cases of glaucoma.

These surgical options are typically considered after evaluating the patient's overall health, the severity of glaucoma, and the response to previous treatments[5][6].

4. Regular Monitoring and Follow-Up

Patients diagnosed with chronic angle-closure glaucoma require regular follow-up appointments to monitor IOP and assess the effectiveness of treatment. Visual field tests and optic nerve assessments are crucial in determining the progression of the disease and the need for adjustments in therapy[7].

Conclusion

Chronic angle-closure glaucoma is a serious condition that necessitates a comprehensive treatment approach, including medications, laser therapy, and potentially surgical interventions. Early diagnosis and timely management are critical to preserving vision and preventing further complications. Regular monitoring and follow-up care are essential components of effective management, ensuring that treatment remains aligned with the patient's evolving needs. If you or someone you know is experiencing symptoms or has been diagnosed with this condition, consulting an ophthalmologist for personalized treatment options is highly recommended.

References

1. Clinical Guideline Glaucoma Surgery Clinical Guideline Glaucoma Surgery.
2. Primary Open-Angle Glaucoma Preferred Practice Pattern.
3. Glaucoma Surgery Glaucoma Surgery.
4. CHAPTER 18 EYE DISORDERS.
5. Validation of Diagnostic Codes to Identify Glaucoma in ...
6. Billing and Coding: Visual Field Examination (A57637).
7. ICD-10 International statistical classification of diseases ... - IRIS.

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-CM code H40.229 specifically refers to chronic angle-closure glaucoma when the affected eye is unspecified. Below is a detailed clinical description and relevant information regarding this condition.

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 intraocular pressure, which may not present with acute symptoms but can result in long-term damage to the optic nerve if left untreated.

Symptoms

Patients with chronic angle-closure glaucoma may experience:
- Gradual loss of peripheral vision: Often unnoticed until significant damage has occurred.
- Halos around lights: This can occur due to corneal edema.
- Mild eye discomfort: Unlike acute angle-closure glaucoma, chronic cases may not present with severe pain.
- Blurred vision: This can be intermittent and may worsen over time.

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, particularly those of Asian descent, have a higher prevalence.
- Family history: A genetic predisposition may play a role.
- Other eye conditions: Conditions such as cataracts or previous eye surgery can contribute to angle closure.

Diagnosis

Clinical Evaluation

Diagnosis typically involves a comprehensive eye examination, including:
- Tonometry: To measure intraocular pressure.
- Gonioscopy: To visualize the anterior chamber angle and assess its openness.
- 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 classified under the broader category of glaucoma in the ICD-10 system. The specific code H40.229 indicates that the condition is chronic and that the eye affected is unspecified, which is important for documentation and treatment planning.

Treatment

Management Strategies

Management of chronic angle-closure glaucoma may include:
- Medications: To lower intraocular pressure, including topical beta-blockers, prostaglandin analogs, and carbonic anhydrase inhibitors.
- Laser therapy: Procedures such as laser peripheral iridotomy or laser iridoplasty can help create a new drainage pathway for aqueous humor.
- Surgical intervention: In some cases, surgical options may be necessary to correct the underlying anatomical issues contributing to angle closure.

Monitoring

Regular follow-up appointments are crucial for monitoring intraocular pressure and assessing the optic nerve for any signs of damage. Patients are often advised to adhere to prescribed treatment regimens and report any changes in vision or discomfort promptly.

Conclusion

Chronic angle-closure glaucoma, classified under ICD-10 code H40.229, is a serious condition that requires careful diagnosis and management to prevent irreversible vision loss. Understanding the clinical features, risk factors, and treatment options is essential for healthcare providers to effectively manage this condition and improve patient outcomes. Regular monitoring and patient education are key components in the long-term management of individuals at risk for or diagnosed with this form of glaucoma.