ICD-10: H40.231

Intermittent angle-closure glaucoma is a specific type of glaucoma characterized by episodes where the drainage angle of the eye becomes temporarily blocked, leading to increased intraocular pressure (IOP). The ICD-10 code H40.231 specifically refers to this condition in the right eye. Below is a detailed clinical description and relevant information regarding this diagnosis.

Clinical Description of Intermittent Angle-Closure Glaucoma

Definition

Intermittent angle-closure glaucoma occurs when the peripheral iris obstructs the trabecular meshwork, which is responsible for draining aqueous humor from the eye. This obstruction can lead to sudden increases in intraocular pressure, resulting in symptoms that may include:

• Eye Pain: Patients often report significant discomfort or pain in the affected eye.
• Visual Disturbances: Blurred vision or halos around lights may occur during episodes.
• Headaches: Patients may experience headaches, particularly around the eye.
• Nausea and Vomiting: In severe cases, the pain and pressure can lead to systemic symptoms like nausea.

Pathophysiology

The condition is often associated with anatomical predispositions, such as a shallow anterior chamber or a thickened lens, which can lead to the iris being pushed forward. This anatomical change can be exacerbated by factors such as dim lighting, which causes the pupil to dilate and further narrows the angle.

Diagnosis

Diagnosis typically involves a comprehensive eye examination, including:

• Tonometry: To measure intraocular pressure.
• Gonioscopy: To visualize the drainage angle and assess its openness.
• Visual Field Testing: To evaluate any loss of peripheral vision.

Treatment

Management of intermittent angle-closure glaucoma may include:

• Medications: To lower intraocular pressure, such as topical beta-blockers, carbonic anhydrase inhibitors, or prostaglandin analogs.
• Laser Therapy: Procedures like laser peripheral iridotomy can create a new drainage pathway for aqueous humor, alleviating the pressure.
• Surgical Options: In some cases, surgical intervention may be necessary to prevent future episodes.

Coding and Documentation

The ICD-10 code H40.231 is used specifically for intermittent angle-closure glaucoma affecting the right eye. Accurate coding is essential for proper billing and treatment documentation. It is important to ensure that the medical records reflect the specific nature of the condition, including any episodes of increased intraocular pressure and the patient's symptoms.

Related Codes

• H40.230: Intermittent angle-closure glaucoma, left eye.
• H40.239: Intermittent angle-closure glaucoma, unspecified eye.

Conclusion

Intermittent angle-closure glaucoma is a significant ocular condition that requires prompt diagnosis and management to prevent permanent vision loss. The ICD-10 code H40.231 specifically identifies this condition in the right eye, facilitating appropriate treatment and documentation. Regular monitoring and patient education are crucial in managing this condition effectively, ensuring that patients are aware of potential triggers and symptoms to seek timely medical attention.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.231, is a specific type of glaucoma characterized by episodes of increased intraocular pressure (IOP) due to the closure of the anterior chamber angle. This condition can lead to significant visual impairment if not managed appropriately. Below is a detailed overview of its clinical presentation, signs, symptoms, and patient characteristics.

Clinical Presentation

Definition and Mechanism

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 be caused by 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[1][2].

Patient Characteristics

Patients with intermittent angle-closure glaucoma often share certain demographic and anatomical characteristics:
- Age: Typically affects older adults, particularly those over 50 years of age.
- Gender: More common in females than males, possibly due to anatomical differences in the eye structure[3].
- Ethnicity: Higher prevalence in individuals of Asian descent, who may have anatomical predispositions such as a narrower anterior chamber angle[4].
- Family History: A family history of glaucoma can increase the risk of developing this condition[5].

Signs and Symptoms

Symptoms

Patients may experience a range of symptoms, particularly during episodes of angle closure:
- Acute Eye Pain: Sudden onset of severe pain in the affected eye, often described as a deep, aching sensation.
- Headache: Associated headaches, particularly around the forehead or temples.
- Nausea and Vomiting: These systemic symptoms can occur due to the severe pain and stress response.
- Blurred Vision: Temporary blurring or loss of vision during acute episodes.
- Halos Around Lights: Patients may report seeing halos around lights, especially at night[6][7].

Signs

During a clinical examination, several signs may be observed:
- Elevated Intraocular Pressure: IOP may be significantly elevated during acute episodes, often exceeding 30 mmHg.
- Redness of the Eye: Conjunctival injection may be present, indicating inflammation.
- Corneal Edema: Swelling of the cornea can occur due to elevated IOP, leading to a cloudy appearance.
- Mid-Dilated Pupil: The pupil may be non-reactive or poorly reactive to light, often mid-dilated due to iris ischemia.
- Shallow Anterior Chamber: Examination may reveal a shallow anterior chamber, particularly in the affected eye[8][9].

Conclusion

Intermittent angle-closure glaucoma (ICD-10 code H40.231) is a serious ocular condition that requires prompt recognition and management to prevent permanent vision loss. Understanding the clinical presentation, including the characteristic symptoms and signs, as well as the typical patient demographics, is crucial for healthcare providers. Early intervention can significantly improve outcomes for affected individuals, emphasizing the importance of regular eye examinations, especially for those at higher risk.

For patients experiencing symptoms suggestive of this condition, immediate consultation with an eye care professional is essential to assess intraocular pressure and determine appropriate treatment options.

Intermittent angle-closure glaucoma, specifically coded as H40.231 in the ICD-10 classification, 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. This condition can lead to significant vision impairment if not managed properly. Below are alternative names and related terms associated with this diagnosis.

Alternative Names

1. Intermittent Narrow-Angle Glaucoma: This term emphasizes the intermittent nature of the angle closure and the narrow angle configuration that predisposes individuals to this condition.
2. Intermittent Angle-Closure Glaucoma: A broader term that may refer to the condition affecting either eye but can be specified as right or left.
3. Acute Angle-Closure Glaucoma: While this typically refers to a sudden onset of symptoms, it can sometimes be used interchangeably in discussions about intermittent episodes.
4. Intermittent Glaucoma: A more general term that may refer to any glaucoma that has episodes of increased pressure, including angle-closure types.

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: This term encompasses both intermittent and chronic forms of angle-closure glaucoma.
3. Intraocular Pressure (IOP): A critical measurement in diagnosing and managing glaucoma, referring to the fluid pressure inside the eye.
4. Visual Field Loss: A potential consequence of untreated angle-closure glaucoma, where peripheral vision may be affected.
5. Pupil Block: A mechanism that can lead to angle-closure glaucoma, where the iris obstructs the drainage angle of the eye.

Clinical Context

Understanding these alternative names and related terms is essential for healthcare professionals when diagnosing and discussing treatment options for patients with H40.231. Proper terminology ensures clear communication among medical staff and aids in accurate documentation and coding for insurance purposes.

In summary, the terminology surrounding intermittent angle-closure glaucoma is varied, reflecting the complexity of the condition and its management. Familiarity with these terms can enhance clinical discussions and improve patient care outcomes.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.231, is a specific type of glaucoma characterized by episodes of increased intraocular pressure due to the closure of the anterior chamber angle. The diagnosis of this condition involves several criteria, which are essential for accurate coding and treatment planning. Below are the key diagnostic criteria typically used for this condition:

Clinical Symptoms

1. Symptoms of Acute Angle-Closure: Patients may present with symptoms such as severe eye pain, headache, nausea, vomiting, and blurred vision. These symptoms often occur suddenly and can be distressing, prompting immediate medical attention.

2. Intermittent Episodes: Unlike chronic angle-closure glaucoma, intermittent angle-closure glaucoma is characterized by episodes where the angle closes temporarily, leading to fluctuating symptoms. Patients may experience periods of normal vision interspersed with episodes of increased intraocular pressure.

Intraocular Pressure (IOP) Measurement

1. Elevated IOP: During episodes, intraocular pressure is typically measured and found to be elevated, often exceeding 21 mmHg. This measurement is crucial for diagnosing glaucoma and differentiating it from other ocular conditions.

2. Tonometry: The use of tonometry, a method for measuring IOP, is essential. Serial tonometry may be employed to assess fluctuations in pressure during episodes of angle closure[8].

Gonioscopy

1. Angle Assessment: Gonioscopy is a critical diagnostic tool that allows for direct visualization of the anterior chamber angle. In intermittent angle-closure glaucoma, the angle may appear narrow or occluded during episodes, but it can be open during asymptomatic periods.

2. Documentation of Angle Closure: The findings from gonioscopy should be documented, noting the degree of angle closure and any changes observed during symptomatic episodes[10].

Visual Field Testing

1. Visual Field Defects: Although not always present in the early stages, visual field testing may reveal defects consistent with glaucoma. This testing helps assess the functional impact of the disease on the patient's vision.

2. Progressive Changes: Over time, if left untreated, intermittent angle-closure glaucoma can lead to progressive visual field loss, which can be documented through perimetry tests.

Additional Considerations

1. Patient History: A thorough patient history is essential, including any previous episodes of eye pain or visual disturbances, family history of glaucoma, and any risk factors such as age, ethnicity, or systemic conditions.

2. Exclusion of Other Conditions: It is important to rule out other causes of elevated IOP and visual symptoms, such as other types of glaucoma or ocular diseases.

Conclusion

The diagnosis of intermittent angle-closure glaucoma (ICD-10 code H40.231) relies on a combination of clinical symptoms, intraocular pressure measurements, gonioscopic findings, and visual field assessments. Accurate diagnosis is crucial for effective management and treatment, which may include medications to lower IOP, laser therapy, or surgical interventions to prevent further episodes and preserve vision. Regular follow-up and monitoring are essential to manage this condition effectively.

Intermittent angle-closure glaucoma (ICD-10 code H40.231) is a type of glaucoma characterized by episodes of increased intraocular pressure due to the closure of the angle between the iris and cornea, which can lead to optic nerve damage if not managed properly. The treatment approaches for this condition typically involve both immediate management during acute episodes and long-term strategies to prevent future occurrences.

Immediate Management

1. Medications

During an acute attack of intermittent angle-closure glaucoma, the primary goal is to lower intraocular pressure (IOP) quickly. Common medications include:

• Topical Beta-Blockers: Such as timolol, which reduce aqueous humor production.
• Alpha Agonists: Like apraclonidine, which also decrease aqueous humor production and increase uveoscleral outflow.
• Carbonic Anhydrase Inhibitors: Such as dorzolamide, which further reduce aqueous humor production.
• Prostaglandin Analogs: These can help increase outflow of aqueous humor.
• Oral Carbonic Anhydrase Inhibitors: Such as acetazolamide, may be used for rapid IOP reduction.

2. Pilocarpine

Pilocarpine, a miotic agent, can be administered to constrict the pupil, which helps to open the angle and facilitate aqueous outflow. However, it is most effective when the IOP is significantly elevated.

3. Systemic Medications

In some cases, systemic medications may be necessary to manage pain and reduce IOP. This can include oral medications or intravenous options in a hospital setting.

Long-term Management

1. Laser Therapy

• Laser Peripheral Iridotomy (LPI): This is the most common and effective long-term treatment for preventing future episodes. It involves creating a small hole in the peripheral iris to allow aqueous humor to flow freely, thereby preventing angle closure.
• Laser Iridoplasty: This may be considered if LPI is not feasible or effective, as it helps to stretch the peripheral iris and open the angle.

2. Surgical Options

In cases where laser therapy is insufficient or if there are anatomical issues, surgical interventions may be necessary. Options include:

• Aqueous Shunts: These devices help to drain excess aqueous humor and lower IOP.
• Trabeculectomy: A surgical procedure that creates a new drainage pathway for aqueous humor.

3. Regular Monitoring

Patients diagnosed with intermittent angle-closure glaucoma should have regular follow-ups to monitor IOP and assess the optic nerve for any signs of damage. Serial tonometry may be employed to track changes in IOP over time.

Patient Education

Educating patients about the signs and symptoms of acute angle-closure glaucoma is crucial. They should be advised to seek immediate medical attention if they experience sudden vision changes, severe eye pain, headache, or nausea.

Conclusion

The management of intermittent angle-closure glaucoma involves a combination of immediate medical treatment during acute episodes and preventive measures to avoid future attacks. Laser therapy, particularly laser peripheral iridotomy, is a cornerstone of long-term management. Regular monitoring and patient education are essential components of a comprehensive treatment plan to preserve vision and prevent complications associated with this condition.