ICD-10: H40.233

Intermittent angle-closure glaucoma, bilateral, is classified under the ICD-10 code H40.233. This condition is a specific type of glaucoma characterized by episodes of increased intraocular pressure (IOP) due to the closure of the angle between the iris and cornea, which can occur intermittently. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description

Definition

Intermittent angle-closure glaucoma occurs when the drainage angle of the eye becomes temporarily blocked, leading to a rise in intraocular pressure. This blockage can happen due to anatomical factors, such as a shallow anterior chamber or a thickened lens, which can push the iris forward and obstruct the angle.

Symptoms

Patients with intermittent angle-closure glaucoma may experience a range of symptoms, including:
- Blurred vision: Often due to fluctuating IOP.
- Halos around lights: A common visual disturbance during episodes.
- Headaches: Often localized around the eyes.
- Eye pain: Can be severe during acute episodes.
- Nausea and vomiting: May accompany acute attacks due to the pain and discomfort.

Diagnosis

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 loss of peripheral vision.

Risk Factors

Several factors can increase the risk of developing intermittent angle-closure glaucoma, including:
- Age: More common in older adults.
- Gender: Women are at a higher risk than men.
- Ethnicity: Higher prevalence in Asian populations.
- Family history: A genetic predisposition may play a role.

Management and Treatment

Acute Management

In cases of acute angle-closure glaucoma, immediate treatment is crucial to lower IOP and relieve symptoms. This may include:
- Medications: Such as carbonic anhydrase inhibitors, beta-blockers, and prostaglandin analogs to reduce IOP.
- Pilocarpine: A miotic agent that can help open the angle.
- Systemic medications: Such as oral carbonic anhydrase inhibitors or intravenous mannitol.

Surgical Options

For patients with recurrent episodes, surgical intervention may be necessary. Options include:
- Laser peripheral iridotomy: A procedure that creates a small hole in the peripheral iris to allow fluid to bypass the blocked area.
- Surgical iridectomy: Removal of a portion of the iris to prevent future attacks.

Long-term Management

Regular follow-up is essential for monitoring IOP and assessing the need for ongoing treatment. Patients may require lifelong management to prevent progression to chronic glaucoma.

Conclusion

Intermittent angle-closure glaucoma, bilateral (ICD-10 code H40.233), is a serious ocular condition that requires prompt diagnosis and management to prevent vision loss. Understanding the symptoms, risk factors, and treatment options is crucial for effective patient care. Regular eye examinations and awareness of the condition can help in early detection and intervention, ultimately preserving vision and improving quality of life for affected individuals.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.233, 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 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.

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 prevalent in females than males, possibly due to anatomical differences in the eye.
- Ethnicity: Higher incidence in Asian populations, where anatomical predispositions are more common.
- Family History: A family history of glaucoma can increase risk, indicating a genetic predisposition.

Signs and Symptoms

Symptoms

Patients may experience a range of symptoms during episodes of angle-closure:
- Acute Eye Pain: Sudden onset of severe pain in the affected eye, often described as throbbing or aching.
- Headache: Often accompanied by a headache, which may be localized to the forehead or temple.
- Nausea and Vomiting: Due to the severity of the pain, patients may experience gastrointestinal symptoms.
- Blurred Vision: Temporary blurring or loss of vision during episodes, often described as halos around lights.
- Photophobia: Increased sensitivity to light, which can exacerbate discomfort.

Signs

During a clinical examination, several signs may be observed:
- Elevated Intraocular Pressure: IOP may be significantly elevated during an acute attack, often exceeding 30 mmHg.
- Redness of the Eye: Conjunctival injection may be present, indicating inflammation.
- Corneal Edema: Swelling of the cornea can occur, leading to a cloudy appearance.
- Mid-Dilated Pupil: The affected eye may show a pupil that is non-reactive or poorly reactive to light.
- Shallow Anterior Chamber: Examination may reveal a shallow anterior chamber, particularly in patients with anatomical predispositions.

Conclusion

Intermittent angle-closure glaucoma (ICD-10 code H40.233) 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 demographics, is crucial for healthcare providers. Early intervention can significantly improve outcomes for affected individuals, highlighting the importance of regular eye examinations, especially for those at higher risk.

Intermittent angle-closure glaucoma, bilateral, is classified under the ICD-10 code H40.233. This specific condition is characterized by episodes of increased intraocular pressure due to the closure of the angle between the iris and cornea, affecting both eyes. 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 Intermittent Angle-Closure Glaucoma: This term emphasizes that the condition affects both eyes and highlights the intermittent nature of the angle closure.
2. Bilateral Intermittent Glaucoma: A more general term that may be used in clinical settings to describe the condition without specifying the angle-closure aspect.
3. Intermittent Bilateral Glaucoma: Similar to the previous term, this variation focuses on the intermittent episodes of glaucoma affecting both eyes.

Related Terms

1. Angle-Closure Glaucoma: A broader category that includes both intermittent and chronic forms of angle-closure glaucoma, which can occur in one or both eyes.
2. Acute Angle-Closure Glaucoma: Refers to a sudden onset of symptoms and increased intraocular pressure, which can be a complication of intermittent angle-closure glaucoma.
3. Chronic Angle-Closure Glaucoma: A condition where the angle remains closed over a longer period, potentially leading to permanent damage if not treated.
4. Primary Angle-Closure Glaucoma: This term is used when the angle closure occurs without any identifiable secondary cause.
5. Secondary Angle-Closure Glaucoma: Refers to angle closure that results from other conditions, such as inflammation or tumors.

Clinical Context

In clinical practice, it is essential to use precise terminology to ensure accurate diagnosis and treatment. The use of alternative names and related terms can help healthcare professionals communicate effectively about the condition, especially when discussing treatment options or patient management strategies.

Understanding these terms is crucial for coding and billing purposes, as well as for research and epidemiological studies related to glaucoma. Accurate coding, such as using H40.233, ensures proper documentation and facilitates appropriate reimbursement for healthcare services provided to patients with this condition[1][2][3].

In summary, while H40.233 specifically refers to intermittent angle-closure glaucoma affecting both eyes, various alternative names and related terms exist that can be used interchangeably in different contexts.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.233, 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. 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, nausea, vomiting, and blurred vision. These symptoms may occur intermittently and can be triggered by factors such as stress or certain medications.
• Family History: A family history of glaucoma can increase the likelihood of developing angle-closure glaucoma.

2. Ocular Examination

• Visual Acuity Testing: Assessing the clarity of vision is essential, as decreased visual acuity may indicate complications from glaucoma.
• Intraocular Pressure (IOP) Measurement: Elevated IOP is a hallmark of glaucoma. In intermittent angle-closure glaucoma, IOP may be elevated during episodes but can return to normal between attacks.
• Gonioscopy: This is a critical diagnostic tool that allows the clinician to visualize the anterior chamber angle. In intermittent angle-closure glaucoma, the angle may appear closed or narrow during episodes but can be open at other times.

3. Visual Field Testing

• Perimetry: This test assesses the peripheral vision, which can be affected in glaucoma. Defects in the visual field may indicate damage to the optic nerve.

4. Optic Nerve Assessment

• Fundoscopy: Examination of the optic nerve head for signs of damage, such as cupping, is essential. Changes in the optic nerve can indicate chronic damage from elevated IOP.

5. Additional Diagnostic Tests

• Pachymetry: Measuring corneal thickness can provide additional information, as thinner corneas may be associated with a higher risk of glaucoma.
• Imaging Studies: Optical coherence tomography (OCT) can be used to assess the structure of the optic nerve and retinal nerve fiber layer.

Diagnostic Criteria Summary

To diagnose intermittent angle-closure glaucoma (H40.233), clinicians typically look for:
- A history of intermittent symptoms consistent with angle-closure episodes.
- Evidence of elevated IOP during episodes.
- Gonioscopic findings showing intermittent closure of the anterior chamber angle.
- Visual field defects and optic nerve changes consistent with glaucoma.

Conclusion

The diagnosis of intermittent angle-closure glaucoma requires a comprehensive approach that includes patient history, clinical examination, and specific diagnostic tests. By carefully evaluating these criteria, healthcare providers can accurately diagnose and manage this condition, ultimately aiming to prevent vision loss associated with glaucoma. Regular monitoring and follow-up are crucial for patients diagnosed with this condition to manage intraocular pressure effectively and address any acute episodes promptly.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.233, is a condition 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 visual impairment if not managed appropriately. Here, we will explore the standard treatment approaches for this condition, including both medical and surgical options.

Medical Management

1. Medications

The first line of treatment for intermittent angle-closure glaucoma typically involves medications aimed at reducing intraocular pressure (IOP) and managing symptoms. Common classes of medications include:

• Topical Prostaglandin Analogs: These medications, such as latanoprost and bimatoprost, help increase aqueous humor outflow, thereby lowering IOP.
• Beta-Blockers: Drugs like timolol can reduce aqueous humor production, contributing to lower IOP.
• Carbonic Anhydrase Inhibitors: Medications such as dorzolamide and brinzolamide also decrease aqueous humor production.
• Alpha Agonists: Brimonidine can both reduce aqueous humor production and increase outflow.
• Oral Carbonic Anhydrase Inhibitors: Acetazolamide may be used in acute situations to rapidly lower IOP.

2. Acute Management

In cases of acute angle-closure attacks, immediate treatment is crucial. This may include:

• Pilocarpine: Administered once the IOP is lowered, pilocarpine helps to constrict the pupil, which can open the angle.
• Systemic Medications: Oral or intravenous medications like acetazolamide can be used to quickly reduce IOP.
• Hyperosmotic Agents: Mannitol may be administered intravenously to draw fluid out of the eye and reduce pressure.

Surgical Management

1. Laser Therapy

Laser procedures are often employed to create a more permanent solution for angle-closure glaucoma:

• 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 flow freely, thus preventing angle closure.
• Laser Iridoplasty: This procedure may be used in cases where LPI is not feasible. It involves applying laser energy to the peripheral iris to stretch it and open the angle.

2. Surgical Options

In cases where laser therapy is insufficient or if there are complications, surgical options may be considered:

• Goniotomy: This involves surgically incising the trabecular meshwork to improve aqueous outflow.
• Trabeculectomy: This procedure creates a new drainage pathway for aqueous humor, effectively lowering IOP.

Follow-Up and Monitoring

Regular follow-up is essential for patients with intermittent angle-closure glaucoma. Monitoring IOP, assessing the optic nerve, and evaluating visual fields are critical 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, particularly bilateral cases as indicated by ICD-10 code H40.233, involves a combination of medical and surgical approaches tailored to the individual patient's needs. Early intervention and regular monitoring are key to preventing vision loss and ensuring optimal outcomes. If you suspect you or someone you know may be experiencing symptoms of this condition, it is crucial to seek prompt evaluation and treatment from an eye care professional.