ICD-10: H40.232

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.232, is a specific type of glaucoma characterized by episodes of increased intraocular pressure (IOP) due to the temporary closure of the angle between the iris and cornea. 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 triggered by various factors, including pupil dilation, which can occur in low light conditions or as a side effect of certain medications.

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.
- Ethnicity: Higher prevalence in individuals of Asian descent, who may have anatomical predispositions such as a narrower anterior chamber angle.
- Family History: A family history of glaucoma can increase the risk of developing this condition.

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: Accompanying headaches, which may be localized to the forehead or temples.
- Nausea and Vomiting: Some patients may experience gastrointestinal symptoms due to the severity of the pain.
- Blurred Vision: Temporary blurring or loss of vision during acute episodes.
- Halos Around Lights: Patients may report seeing halos around lights, particularly at night.

Signs

During a clinical examination, several signs may indicate intermittent angle-closure glaucoma:
- Elevated Intraocular Pressure: Measurement of IOP may reveal elevated levels, often exceeding 21 mmHg during acute episodes.
- Redness of the Eye: Conjunctival injection may be observed, indicating inflammation.
- Corneal Edema: Swelling of the cornea can occur, leading to a cloudy appearance.
- Mid-Dilated Pupil: The affected eye may exhibit a mid-dilated, non-reactive pupil during an acute attack.
- Shallow Anterior Chamber: Examination may reveal a shallow anterior chamber, particularly in the affected eye.

Conclusion

Intermittent angle-closure glaucoma (ICD-10 code H40.232) is a serious ocular condition that requires prompt recognition and management to prevent permanent vision loss. Understanding the clinical presentation, including the characteristic signs and symptoms, as well as the typical patient profile, is crucial for healthcare providers. Early intervention, often involving medications to lower intraocular pressure and potential surgical options to prevent future episodes, is essential for preserving vision and improving patient outcomes. Regular eye examinations are recommended for at-risk populations to monitor for signs of glaucoma and facilitate early detection and treatment.

Intermittent angle-closure glaucoma (ICD-10 code H40.232) is a condition characterized by episodes of increased intraocular pressure due to the closure of the angle between the iris and cornea, which can lead to vision loss if not managed appropriately. The treatment approaches for this condition typically involve both immediate management during acute episodes and long-term strategies to prevent recurrence.

Immediate Management

1. Medications

During an acute attack of intermittent angle-closure glaucoma, the following medications are commonly used to lower intraocular pressure (IOP):

• Topical Beta-Blockers: Medications such as timolol can reduce aqueous humor production.
• Alpha Agonists: Apraclonidine or brimonidine can also decrease aqueous humor production and increase uveoscleral outflow.
• Carbonic Anhydrase Inhibitors: Drugs like dorzolamide can further reduce aqueous humor production.
• Prostaglandin Analogs: Latanoprost may be used to enhance outflow.
• Oral Carbonic Anhydrase Inhibitors: Acetazolamide can be administered for rapid IOP reduction.

2. Pilocarpine

Pilocarpine, a miotic agent, can be used to constrict the pupil, which helps to open the angle and facilitate aqueous outflow, particularly in acute settings.

3. Systemic Medications

In some cases, systemic medications such as oral carbonic anhydrase inhibitors or hyperosmotic agents (e.g., mannitol) may be utilized to rapidly decrease IOP.

Surgical and Laser Interventions

1. Laser Peripheral Iridotomy (LPI)

LPI is often the definitive treatment for angle-closure glaucoma. This procedure creates a small hole in the peripheral iris, allowing aqueous humor to bypass the blocked angle and flow freely into the anterior chamber. It is typically performed as an outpatient procedure and is effective in preventing future episodes of angle closure.

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.

3. Surgical Options

If laser treatments are insufficient or if there are anatomical issues, surgical options such as trabeculectomy or the placement of aqueous shunts may be considered to manage IOP effectively.

Long-term Management

1. Regular Monitoring

Patients diagnosed with intermittent angle-closure glaucoma should have regular follow-up appointments to monitor IOP and assess the health of the optic nerve. Serial tonometry may be employed to track changes in IOP over time[10].

2. Patient Education

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

3. Lifestyle Modifications

Encouraging lifestyle changes, such as maintaining a healthy weight and managing systemic conditions like diabetes and hypertension, can also contribute to overall eye health.

Conclusion

The management of intermittent angle-closure glaucoma (H40.232) involves a combination of immediate medical treatment during acute episodes, definitive surgical interventions like laser peripheral iridotomy, and ongoing monitoring to prevent future attacks. By employing a comprehensive approach, healthcare providers can effectively manage this condition and preserve patients' vision. Regular follow-ups and patient education play vital roles in ensuring long-term success in managing this potentially sight-threatening condition.

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). This condition can result in visual disturbances and, if left untreated, may lead to permanent vision loss. Below is a detailed clinical description and relevant information regarding the ICD-10 code H40.232, which specifically refers to intermittent angle-closure glaucoma in the left eye.

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, causing symptoms such as:

• Blurred vision
• Halos around lights
• Severe eye pain
• Headaches
• Nausea and vomiting

These symptoms may resolve when the angle reopens, but repeated episodes can lead to chronic damage to the optic nerve.

Pathophysiology

The condition is often associated with anatomical predispositions, such as a shallow anterior chamber or a thickened lens, which can increase the risk of angle closure. Factors that may trigger episodes include:

• Pupil dilation (e.g., in low light or due to certain medications)
• Stress or emotional factors
• Certain medications (e.g., anticholinergics)

Diagnosis

Diagnosis typically involves a comprehensive eye examination, including:

• Tonometry: To measure intraocular pressure.
• Gonioscopy: To visualize the drainage angle of the eye.
• Visual field testing: To assess any loss of peripheral vision.

Treatment

Management of intermittent angle-closure glaucoma may include:

• Medications: To lower intraocular pressure, such as topical beta-blockers or carbonic anhydrase inhibitors.
• Laser therapy: Such as laser peripheral iridotomy, which creates a small hole in the peripheral iris to improve aqueous humor drainage.
• Surgical intervention: In cases where laser treatment is insufficient or not feasible.

ICD-10 Code H40.232

Specifics of the Code

• Code: H40.232
• Description: Intermittent angle-closure glaucoma, left eye
• Classification: This code falls under the broader category of glaucoma (H40), specifically indicating the laterality (left eye) and the intermittent nature of the angle-closure.

Importance of Accurate Coding

Accurate coding is crucial for proper diagnosis, treatment planning, and reimbursement processes. It ensures that healthcare providers can effectively communicate the patient's condition and the necessary interventions.

Documentation Requirements

When documenting this condition, it is essential to include:

• Patient symptoms: Documenting the frequency and severity of episodes.
• Diagnostic findings: Results from tonometry and gonioscopy.
• Treatment history: Any previous interventions or medications used.

Conclusion

Intermittent angle-closure glaucoma, particularly as denoted by ICD-10 code H40.232 for the left eye, is a significant ocular condition that requires prompt diagnosis and management to prevent long-term complications. Understanding the clinical aspects, diagnostic criteria, and treatment options is vital for healthcare providers to ensure optimal patient outcomes. Regular monitoring and patient education about recognizing symptoms can also play a crucial role in managing this condition effectively.

Intermittent angle-closure glaucoma, specifically coded as H40.232 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. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Here’s a detailed overview:

Alternative Names for H40.232

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 more general term that can refer to the condition affecting either eye, but in this context, it specifically pertains to the left eye.

3. Acute Angle-Closure Glaucoma: While this term typically refers to a more severe and sudden onset of symptoms, it is sometimes used interchangeably in discussions about angle-closure types, although it is technically distinct.

4. Left Eye Angle-Closure Glaucoma: This term specifies the affected eye, which is crucial for accurate diagnosis and treatment planning.

Related Terms

1. Glaucoma: A broader category that includes various types of glaucoma, including open-angle and angle-closure glaucoma.

2. Intraocular Pressure (IOP): A critical measurement in diagnosing and managing glaucoma, as elevated IOP is a common feature of this condition.

3. Pupillary Block: A mechanism often involved in angle-closure glaucoma, where the flow of aqueous humor is obstructed, leading to increased pressure.

4. Visual Field Loss: A potential consequence of untreated angle-closure glaucoma, highlighting the importance of early detection and management.

5. Ocular Hypertension: A condition that may precede glaucoma, characterized by elevated intraocular pressure without the optic nerve damage typical of glaucoma.

6. Gonioscopy: A diagnostic procedure used to examine the angle of the anterior chamber of the eye, crucial for diagnosing angle-closure glaucoma.

7. Laser Peripheral Iridotomy: A common treatment for angle-closure glaucoma, this procedure creates a small hole in the peripheral iris to improve fluid drainage.

Conclusion

Understanding the alternative names and related terms for ICD-10 code H40.232 is essential for healthcare professionals involved in the diagnosis and treatment of glaucoma. This knowledge aids in effective communication, accurate documentation, and comprehensive patient care. If you have further questions or need additional information on this topic, feel free to ask!

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.232, 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 may report episodes of eye pain, headache, blurred vision, halos around lights, and nausea or vomiting. These symptoms often occur suddenly and can be severe.
• Previous Episodes: A history of intermittent episodes of increased intraocular pressure or previous acute angle-closure glaucoma can indicate a predisposition to this condition.

2. Ocular Examination

• Visual Acuity: Assessment of visual acuity is essential to determine any impact on vision.
• Intraocular Pressure (IOP): Measurement of IOP is critical. In intermittent angle-closure glaucoma, IOP may be elevated during episodes but can return to normal between episodes.
• Pupil Reaction: A relative afferent pupillary defect may be present, indicating potential damage to the optic nerve or retina.

3. Gonioscopy

• Angle Assessment: Gonioscopy is a key diagnostic tool that allows the clinician to visualize the anterior chamber angle. In intermittent angle-closure glaucoma, the angle may appear narrow or occluded during episodes, but it can be open during periods of normal IOP.

4. Visual Field Testing

• Field Defects: Perimetry may reveal characteristic visual field defects associated with glaucoma, although these may not be present in the early stages of intermittent angle-closure glaucoma.

5. Optic Nerve Evaluation

• Optic Nerve Head Examination: The optic nerve head should be examined for signs of damage, such as cupping or pallor, which can indicate glaucomatous changes.

Additional Diagnostic Considerations

1. Imaging Techniques

• Optical Coherence Tomography (OCT): This imaging technique can be used to assess the retinal nerve fiber layer and ganglion cell layer, providing additional information about the health of the optic nerve.

2. Risk Factors

• Demographics: Certain populations, particularly older adults, women, and individuals of Asian descent, are at higher risk for angle-closure glaucoma.
• Anatomical Features: Patients with hyperopia (farsightedness) or a shallow anterior chamber are more susceptible to angle-closure episodes.

3. Differential Diagnosis

• It is important to differentiate intermittent angle-closure glaucoma from other types of glaucoma and ocular conditions that may present with similar symptoms.

Conclusion

The diagnosis of intermittent angle-closure glaucoma (ICD-10 code H40.232) relies on a comprehensive evaluation that includes patient history, ocular examination, gonioscopy, and imaging techniques. Recognizing the symptoms and understanding the risk factors are crucial for timely diagnosis and management. Early intervention can help prevent progression to more severe forms of glaucoma, which can lead to irreversible vision loss. Regular follow-up and monitoring are essential for patients diagnosed with this condition to manage intraocular pressure effectively and preserve vision.