ICD-10: H40.239

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 symptoms such as blurred vision, eye pain, headache, and nausea, particularly during acute episodes. The ICD-10 code H40.239 specifically refers to intermittent angle-closure glaucoma when the affected eye is unspecified, meaning that the documentation does not specify whether it is the right or left eye.

Clinical Description

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 IOP, although these increases may not be constant and can fluctuate, hence the term "intermittent" [1].

Symptoms

Patients may experience a range of symptoms during an episode, including:
- Blurred vision: Often due to corneal edema or changes in the shape of the lens.
- Eye pain: This can be severe and may be accompanied by a feeling of pressure.
- Headaches: Often localized around the eye or forehead.
- Nausea and vomiting: These symptoms can occur due to the pain and discomfort associated with the condition.
- Halos around lights: This visual disturbance is caused by corneal swelling.

Risk Factors

Several factors can increase the risk of developing intermittent angle-closure glaucoma, including:
- Age: Older adults are at higher risk.
- Gender: Women are more frequently affected than men.
- Hyperopia (farsightedness): Individuals with hyperopia may have a shallower anterior chamber, increasing the risk of angle closure.
- Family history: A genetic predisposition can play a role in the development of glaucoma.

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 IOP, 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, preventing future episodes.
- Surgery: In some cases, surgical intervention may be necessary to correct anatomical issues contributing to the angle closure.

Conclusion

ICD-10 code H40.239 is crucial for accurately documenting and billing for cases of intermittent angle-closure glaucoma when the specific eye affected is not identified. Understanding the clinical features, risk factors, and treatment options is essential for healthcare providers to manage this condition effectively and prevent potential complications, such as permanent vision loss. Regular monitoring and patient education are vital components of care for individuals at risk of this type of glaucoma [2][3].

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.239, is a specific type of glaucoma characterized by episodes of increased intraocular pressure 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

Signs and Symptoms

Patients with intermittent angle-closure glaucoma may experience a range of symptoms, which can vary in intensity and duration. Common signs and symptoms include:

• Visual Disturbances: Patients often report blurred vision or halos around lights, particularly during episodes of increased intraocular pressure[11].
• Eye Pain: Acute episodes may be accompanied by significant ocular pain, which can be severe and debilitating[11][14].
• Headaches: Patients may experience headaches, often localized around the eye or forehead, coinciding with episodes of increased pressure[11].
• Nausea and Vomiting: Some patients may experience gastrointestinal symptoms, including nausea and vomiting, particularly during acute attacks[11][14].
• Redness of the Eye: Conjunctival injection or redness may be observed during episodes of angle closure[14].
• Pupil Changes: The affected eye may exhibit a mid-dilated, non-reactive pupil during acute episodes, contrasting with the normal response of the unaffected eye[11][14].

Patient Characteristics

Certain demographic and clinical characteristics are commonly associated with intermittent angle-closure glaucoma:

• Age: This condition is more prevalent in older adults, particularly those over the age of 60, as the risk of angle closure increases with age[11][12].
• Gender: Women are more frequently affected than men, possibly due to anatomical differences in the eye[11][12].
• Ethnicity: Certain ethnic groups, particularly those of Asian descent, have a higher incidence of angle-closure glaucoma due to anatomical predispositions[11][12].
• Family History: A family history of glaucoma can increase the risk of developing intermittent angle-closure glaucoma, indicating a genetic predisposition[11][12].
• Hyperopia: Individuals with hyperopia (farsightedness) are at a greater risk, as their eyes may have a more shallow anterior chamber, predisposing them to angle closure[11][12].

Diagnosis and Management

Diagnosis typically involves a comprehensive eye examination, including:

• Tonometry: To measure intraocular pressure, which may be elevated during episodes[11][14].
• Gonioscopy: To assess the angle of the anterior chamber and determine the presence of closure[11][14].
• Visual Field Testing: To evaluate any potential loss of peripheral vision, which can occur with prolonged elevated intraocular pressure[11][14].

Management strategies may include medications to lower intraocular pressure, laser therapy to create a new drainage pathway, or surgical interventions in more severe cases[11][12][14].

Conclusion

Intermittent angle-closure glaucoma is a significant ocular condition that requires prompt recognition and management to prevent irreversible vision loss. Understanding its clinical presentation, signs, symptoms, and patient characteristics is essential for healthcare providers to ensure effective diagnosis and treatment. Regular eye examinations, especially for at-risk populations, can aid in early detection and intervention, ultimately preserving vision and improving patient outcomes.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.239, 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 Angle-Closure Glaucoma: This is the primary alternative name, emphasizing the episodic nature of the condition.
2. Intermittent Glaucoma: A broader term that may refer to various types of glaucoma that exhibit intermittent symptoms.
3. Acute Angle-Closure Glaucoma: While this term typically refers to a more severe and sudden onset of angle-closure glaucoma, it can sometimes be used interchangeably in discussions about intermittent episodes.
4. Intermittent Narrow-Angle Glaucoma: This term highlights the anatomical aspect of the condition, focusing on the narrow angle that can lead to closure.

Related Terms

1. Glaucoma: A general term for a group of eye conditions that damage the optic nerve, often associated with high intraocular pressure.
2. Angle-Closure Glaucoma: A broader category that includes both intermittent and acute forms of angle-closure glaucoma.
3. Intraocular Pressure (IOP): A critical measurement in diagnosing and managing glaucoma, as elevated IOP is a common feature of this condition.
4. Visual Field Loss: A potential consequence of untreated glaucoma, referring to the loss of peripheral vision.
5. Ocular Hypertension: A condition where the intraocular pressure is higher than normal, which can lead to glaucoma if not monitored.

Clinical Context

Understanding these alternative names and related terms is essential for healthcare professionals when diagnosing and discussing treatment options for patients with intermittent angle-closure glaucoma. Accurate terminology ensures effective communication among medical staff and aids in the proper coding and billing processes related to this condition.

In summary, the ICD-10 code H40.239 encompasses various terminologies that reflect the nature and implications of intermittent angle-closure glaucoma, which is crucial for both clinical practice and patient education.

Intermittent angle-closure glaucoma, classified under ICD-10 code H40.239, 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, we outline the key 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 during acute attacks. A history of intermittent symptoms is crucial for diagnosis.
• Family History: A family history of glaucoma can increase the likelihood of diagnosis, as genetic factors play a role in the disease's prevalence.

2. Ocular Examination

• Visual Acuity Testing: Assessing the clarity of vision is essential. Patients may experience reduced visual acuity during acute episodes.
• Intraocular Pressure (IOP) Measurement: Elevated IOP is a hallmark of glaucoma. In intermittent angle-closure glaucoma, IOP may be normal between episodes but elevated during acute attacks.
• Gonioscopy: This procedure allows for direct visualization of the anterior chamber angle. In intermittent angle-closure glaucoma, the angle may appear narrow or closed during episodes but can be open when the patient is asymptomatic.

3. Visual Field Testing

• Perimetry: Visual field tests can help identify any peripheral vision loss, which may occur as the disease progresses. In early stages, visual fields may be normal, but defects can develop over time.

4. Optic Nerve Assessment

• Fundoscopy: Examination of the optic nerve head for signs of damage, such as cupping, is critical. Changes in the optic nerve can indicate glaucoma progression.

5. Additional Diagnostic Tests

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

Conclusion

The diagnosis of intermittent angle-closure glaucoma (ICD-10 code H40.239) relies on a comprehensive evaluation that includes patient history, ocular examination, intraocular pressure measurement, and additional diagnostic tests. Clinicians must consider both symptomatic episodes and the results of objective tests to confirm the diagnosis and determine the appropriate management strategy. Early detection and treatment are crucial to prevent vision loss associated with this condition.

Intermittent angle-closure glaucoma (ICD-10 code H40.239) 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 medical and surgical interventions aimed at controlling intraocular pressure and preventing further episodes.

Medical Management

1. Medications

• Topical Prostaglandin Analogs: These are often the first-line treatment for lowering intraocular pressure (IOP). They work by increasing the outflow of aqueous humor, thereby reducing pressure in the eye. Common examples include latanoprost and bimatoprost.
• Beta-Blockers: Medications such as timolol can be used to decrease aqueous humor production, thus lowering IOP.
• Alpha Agonists: Drugs like brimonidine can also reduce IOP by decreasing aqueous humor production and increasing outflow.
• Carbonic Anhydrase Inhibitors: Oral medications like acetazolamide may be prescribed in acute situations to rapidly lower IOP.
• Miotics: Pilocarpine can be used to constrict the pupil, which may help open the angle in some cases.

2. Acute Management

• In cases of acute angle-closure attacks, immediate treatment is critical. This may include:
  • Oral or IV Carbonic Anhydrase Inhibitors: To quickly reduce IOP.
  • Hyperosmotic Agents: Such as mannitol, which can draw fluid out of the eye and reduce pressure.
  • Pilocarpine: Administered after IOP is lowered to help open the angle.

Surgical Management

1. Laser Procedures

• 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 preventing future attacks.
• 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. Aqueous Shunts and Stents

• In more advanced cases or when medical management fails, surgical options such as aqueous shunts or stents may be considered. These devices help to drain excess aqueous humor and lower IOP effectively.

Follow-Up and Monitoring

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

Conclusion

The management of intermittent angle-closure glaucoma (H40.239) requires a comprehensive approach that includes both medical and surgical strategies. Early intervention is key to preventing vision loss, and ongoing monitoring is essential to ensure effective control of intraocular pressure. Patients should work closely with their ophthalmologists to determine the most appropriate treatment plan tailored to their specific needs and circumstances.