ICD-10: H40.23

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.23, is a specific type of glaucoma characterized by episodes of increased intraocular pressure (IOP) due to the temporary closure of the anterior chamber angle. This condition can lead to significant visual impairment if not managed appropriately. Below is a detailed overview of this condition, including its clinical description, symptoms, diagnosis, and management.

Clinical Description

Definition

Intermittent angle-closure glaucoma occurs when the drainage angle of the eye becomes temporarily obstructed, leading to a rise in intraocular pressure. This obstruction can happen due to anatomical factors, such as a shallow anterior chamber or a thickened lens, which can push the iris forward and block the trabecular meshwork, the primary drainage pathway for aqueous humor.

Pathophysiology

In this condition, the angle closure is not permanent; it can open and close intermittently. During episodes of closure, the IOP can spike significantly, potentially causing damage to the optic nerve and resulting in visual field loss. The intermittent nature of this condition can make it challenging to diagnose, as patients may not experience symptoms during periods of normal IOP.

Symptoms

Patients with intermittent angle-closure glaucoma may experience a range of symptoms, particularly during episodes of increased IOP. Common symptoms include:

• Blurred vision: Sudden changes in vision clarity.
• Halos around lights: Patients may notice colored rings around lights, especially at night.
• Eye pain: This can range from mild discomfort to severe pain.
• Headaches: Often associated with the eye pain.
• Nausea and vomiting: These symptoms can occur due to the severe pain and stress of the condition.

Diagnosis

Clinical Evaluation

Diagnosis typically involves a comprehensive eye examination, including:

• Tonometry: To measure intraocular pressure.
• Gonioscopy: To assess the angle of the anterior chamber and determine if it is open or closed.
• Visual field testing: To evaluate any potential loss of peripheral vision.
• Optic nerve assessment: Using imaging techniques to check for damage.

Differential Diagnosis

It is essential to differentiate intermittent angle-closure glaucoma from other types of glaucoma and ocular conditions, such as primary open-angle glaucoma and acute angle-closure glaucoma, which presents more acutely and requires immediate intervention.

Management

Treatment Options

Management of intermittent angle-closure glaucoma focuses on both acute episodes and long-term control of intraocular pressure. Treatment options include:

• Medications: Topical medications such as prostaglandin analogs, beta-blockers, and carbonic anhydrase inhibitors can help lower IOP.
• Laser therapy: Laser peripheral iridotomy is often performed to create a small hole in the peripheral iris, allowing aqueous humor to bypass the blocked angle and reduce IOP.
• Surgical intervention: In some cases, surgical procedures may be necessary to correct anatomical issues contributing to angle closure.

Monitoring

Regular follow-up appointments are crucial for monitoring IOP and assessing the optic nerve for any signs of damage. Patients should be educated about recognizing symptoms of acute episodes and the importance of seeking immediate care if they occur.

Conclusion

Intermittent angle-closure glaucoma is a significant ocular condition that requires careful diagnosis and management to prevent vision loss. Understanding its clinical features, symptoms, and treatment options is essential for healthcare providers to ensure timely intervention and optimal patient outcomes. Regular monitoring and patient education play critical roles in managing this condition effectively.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.23, is a specific type of glaucoma characterized by episodes of increased intraocular pressure (IOP) due to the temporary closure of the anterior chamber angle. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management.

Clinical Presentation

Definition and Mechanism

Intermittent angle-closure glaucoma occurs when the peripheral iris bows forward, obstructing the drainage angle of the eye. This can lead to episodes of elevated IOP, which may resolve spontaneously or with treatment. Unlike primary angle-closure glaucoma, which is more acute and persistent, intermittent angle-closure glaucoma features episodes that may not always result in permanent damage to the optic nerve if managed appropriately[1][2].

Patient Characteristics

Patients with intermittent angle-closure glaucoma often share certain demographic and clinical characteristics:
- Age: Typically affects older adults, particularly those over 50 years of age.
- Gender: More common in women than men, possibly due to anatomical differences in the eye[1].
- Ethnicity: Higher prevalence in Asian populations, likely due to anatomical predispositions such as a narrower anterior chamber angle[2].
- Family History: A family history of glaucoma may increase risk, indicating a genetic component[1].

Signs and Symptoms

Symptoms

Patients may experience a range of symptoms during episodes of angle closure, including:
- Blurred Vision: Often described as a sudden change in vision clarity, which may fluctuate with episodes.
- Halos Around Lights: Patients may report seeing halos, particularly at night or in low-light conditions, due to corneal edema caused by elevated IOP[1].
- Eye Pain or Discomfort: This can range from mild discomfort to severe pain, often described as a deep ache in the eye or brow area.
- Headaches: Patients may experience headaches, particularly around the forehead or temples, coinciding with episodes of increased IOP[2].
- Nausea and Vomiting: In some cases, elevated IOP can lead to systemic symptoms such as nausea, which may mimic migraine symptoms[1].

Signs

During a clinical examination, several signs may indicate intermittent angle-closure glaucoma:
- Elevated Intraocular Pressure: IOP measurements may show spikes during episodes, often exceeding 21 mmHg[2].
- Shallow Anterior Chamber: A shallow anterior chamber can be observed during slit-lamp examination, indicating potential angle closure[1].
- Iris Configuration: The iris may appear bowed or displaced, particularly in the peripheral region, suggesting angle closure[2].
- Corneal Edema: Swelling of the cornea may be present, particularly during acute episodes, leading to a hazy appearance[1].

Conclusion

Intermittent angle-closure glaucoma is a significant ocular condition that requires careful monitoring and management. Recognizing the clinical presentation, signs, symptoms, and patient characteristics is essential for healthcare providers to ensure timely intervention and prevent potential vision loss. Regular eye examinations and awareness of risk factors can aid in early detection and management of this condition, ultimately improving patient outcomes.

Intermittent angle-closure glaucoma, classified under the ICD-10 code H40.23, is a specific type of glaucoma characterized by episodes of increased intraocular pressure due to the closure of the angle between the iris and cornea. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Here’s a detailed overview:

Alternative Names for Intermittent Angle-Closure Glaucoma

1. Intermittent Glaucoma: This term emphasizes the episodic nature of the condition, where symptoms may not be constant but occur intermittently.
2. Intermittent Angle-Closure Glaucoma: A slight variation that maintains the focus on the angle-closure aspect while highlighting its intermittent nature.
3. Intermittent Narrow-Angle Glaucoma: This term refers to the narrow angle between the iris and cornea that can lead to closure episodes, emphasizing the anatomical aspect of the condition.

Related Terms

1. Angle-Closure Glaucoma: A broader category that includes both intermittent and primary angle-closure glaucoma, referring to any condition where the angle is obstructed.
2. Primary Angle-Closure Glaucoma (PACG): This term refers to a more severe and chronic form of angle-closure glaucoma, which may not have intermittent episodes.
3. Acute Angle-Closure Glaucoma: This term describes a sudden onset of symptoms, often requiring immediate medical attention, and is distinct from the intermittent nature of H40.23.
4. Chronic Angle-Closure Glaucoma: Refers to a long-term condition where the angle remains closed, leading to sustained intraocular pressure.
5. Narrow-Angle Glaucoma: A general term that can refer to any form of glaucoma associated with a narrow anterior chamber angle, including intermittent forms.

Clinical Context

Understanding these terms is crucial for healthcare professionals involved in the diagnosis, treatment, and coding of glaucoma-related conditions. Accurate terminology ensures proper coding for insurance and billing purposes, as well as effective communication among medical teams.

In summary, while H40.23 specifically denotes intermittent angle-closure glaucoma, various alternative names and related terms exist that reflect its characteristics and relationship to other forms of glaucoma. This knowledge is essential for precise medical documentation and effective patient care.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.23, is a specific type of glaucoma characterized by episodes of increased intraocular pressure due to the closure of the anterior chamber angle. Diagnosing this condition involves a combination of clinical evaluation, patient history, and specific diagnostic criteria. Below is a detailed overview of the criteria used for diagnosis.

Clinical Criteria for Diagnosis

1. Patient History

• Symptoms: Patients often report episodes of eye pain, headache, blurred vision, halos around lights, and nausea or vomiting during acute attacks. A history of intermittent symptoms can be indicative of angle-closure episodes.
• Family History: A family history of glaucoma may increase the likelihood of developing angle-closure glaucoma.

2. Ocular Examination

• Visual Acuity Testing: Assessing the clarity of vision can help determine the impact of glaucoma on the patient's sight.
• Intraocular Pressure (IOP) Measurement: Elevated IOP is a hallmark of glaucoma. In intermittent angle-closure glaucoma, IOP may be elevated during acute episodes but can return to normal between attacks.
• Pupil Reaction: A relative afferent pupillary defect may be observed in affected eyes.

3. Gonioscopy

• Angle Assessment: Gonioscopy is crucial for visualizing the anterior chamber angle. In intermittent angle-closure glaucoma, the angle may appear closed or narrow during episodes, but it can be open during asymptomatic periods.

4. Visual Field Testing

• Perimetry: Visual field tests can reveal characteristic defects associated with glaucoma, such as peripheral vision loss. In intermittent cases, these defects may not be present during non-acute phases.

5. Optic Nerve Assessment

• Fundoscopy: Examination of the optic nerve head can reveal changes such as cupping, which is indicative of glaucoma. In intermittent cases, these changes may be subtle or develop over time.

Diagnostic Imaging

• Optical Coherence Tomography (OCT): This imaging technique can provide detailed cross-sectional images of the retina and optic nerve, helping to assess structural changes associated with glaucoma.

Conclusion

The diagnosis of intermittent angle-closure glaucoma (ICD-10 code H40.23) relies on a comprehensive evaluation that includes patient history, clinical symptoms, intraocular pressure measurements, gonioscopy, visual field testing, and optic nerve assessment. Early diagnosis and management are crucial to prevent vision loss associated with this condition. If you suspect angle-closure glaucoma, it is essential to consult an eye care professional for a thorough examination and appropriate treatment options.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.23, is a condition characterized by episodes of increased intraocular pressure due to the closure of the anterior chamber angle. This condition can lead to significant visual impairment if not managed appropriately. The management of intermittent angle-closure glaucoma typically involves both medical and surgical approaches, tailored to the severity of the condition and the patient's overall health.

Medical Management

1. Medications

The initial treatment often includes medications aimed at lowering intraocular pressure (IOP) and managing symptoms. Common classes of medications include:

• Topical Prostaglandin Analogs: These medications, such as latanoprost and bimatoprost, increase aqueous humor outflow, thereby reducing IOP.
• Beta-Blockers: Agents like timolol can decrease aqueous humor production.
• Carbonic Anhydrase Inhibitors: Medications such as dorzolamide help reduce IOP by decreasing the production of aqueous humor.
• Alpha Agonists: Brimonidine can also lower IOP by both decreasing aqueous humor production and increasing uveoscleral outflow.

2. Oral Medications

In acute situations, oral carbonic anhydrase inhibitors (e.g., acetazolamide) may be used to rapidly lower IOP. Additionally, hyperosmotic agents like mannitol can be administered to reduce IOP quickly in emergency settings.

3. Pilocarpine

In cases where the angle is open, pilocarpine, a miotic agent, can be used to constrict the pupil and pull the peripheral iris away from the angle, potentially reopening it.

Surgical Management

When medical therapy is insufficient or if the patient experiences recurrent episodes, surgical intervention may be necessary. The following surgical options are commonly considered:

1. Laser Peripheral Iridotomy (LPI)

LPI is the most common surgical 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 directly from the posterior to the anterior chamber, thereby preventing angle closure.

2. Laser Iridoplasty

This procedure is sometimes used as an alternative to LPI, particularly in cases where the iris is too thick or the angle is too narrow. It involves applying laser energy to the peripheral iris to stretch it and open the angle.

3. Surgical Iridectomy

In some cases, a surgical iridectomy may be performed, where a portion of the iris is surgically removed to create a new drainage pathway for aqueous humor.

4. Trabeculectomy

For patients with persistent IOP despite other treatments, trabeculectomy may be indicated. This procedure creates a new drainage pathway for aqueous humor, effectively lowering IOP.

Follow-Up and Monitoring

Regular follow-up is crucial for patients with intermittent angle-closure glaucoma. Monitoring IOP, assessing the optic nerve, and evaluating visual fields are essential components of ongoing care. Adjustments to treatment may be necessary based on the patient's response and any changes in their condition.

Conclusion

The management of intermittent angle-closure glaucoma involves a combination of medical and surgical strategies aimed at controlling intraocular pressure and preventing damage to the optic nerve. Early diagnosis and appropriate treatment are vital 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 H40.23.