ICD-10: H40.24

Clinical Description of ICD-10 Code H40.24: Residual Stage of Angle-Closure Glaucoma

Overview of Angle-Closure Glaucoma

Angle-closure glaucoma is a type of glaucoma characterized by a sudden increase in intraocular pressure (IOP) due to the blockage of the drainage angle formed by the cornea and iris. This condition can lead to severe vision loss if not treated promptly. The residual stage of angle-closure glaucoma, denoted by ICD-10 code H40.24, refers to the state of the disease after an acute episode has been resolved but where some degree of damage or dysfunction persists.

Clinical Features

1. Symptoms: Patients in the residual stage may experience ongoing symptoms such as:
   - Blurred vision
   - Halos around lights
   - Eye discomfort or pain
   - Headaches

2. Intraocular Pressure: While the acute rise in IOP may have been managed, patients may still have elevated IOP levels compared to normal, which can contribute to further optic nerve damage over time.

3. Visual Field Loss: There may be permanent visual field defects due to previous episodes of elevated IOP, which can affect the patient's quality of life and visual function.

4. Optic Nerve Damage: The residual stage often indicates that there has been some degree of optic nerve damage, which can be assessed through imaging techniques or visual field testing.

Diagnosis and Management

Diagnosis: The diagnosis of residual angle-closure glaucoma typically involves:
- Comprehensive eye examinations, including tonometry to measure IOP.
- Gonioscopy to evaluate the drainage angle.
- Visual field tests to assess any loss of peripheral vision.
- Optical coherence tomography (OCT) to evaluate the optic nerve head and retinal nerve fiber layer.

Management: Treatment strategies for managing residual angle-closure glaucoma may include:
- Medications: Topical medications to lower IOP, such as prostaglandin analogs, beta-blockers, or carbonic anhydrase inhibitors.
- Laser Therapy: Procedures like laser peripheral iridotomy or laser iridoplasty may be performed to improve aqueous humor outflow and prevent further episodes.
- Surgical Options: In some cases, surgical intervention may be necessary to create a new drainage pathway or to address any structural issues contributing to the angle closure.

Prognosis

The prognosis for patients with residual angle-closure glaucoma varies based on the extent of optic nerve damage and the effectiveness of ongoing management strategies. Regular follow-up and monitoring are crucial to prevent further vision loss and to manage IOP effectively.

Conclusion

ICD-10 code H40.24 identifies the residual stage of angle-closure glaucoma, highlighting the importance of ongoing management and monitoring after an acute episode. Understanding the clinical features, diagnostic approaches, and treatment options is essential for healthcare providers to optimize patient outcomes and preserve vision. Regular assessments and tailored treatment plans can significantly impact the quality of life for individuals affected by this condition.

The ICD-10 code H40.24 refers to the residual stage of angle-closure glaucoma, a condition characterized by specific clinical presentations, signs, symptoms, and patient characteristics. Understanding these aspects is crucial for accurate diagnosis and management.

Clinical Presentation

Angle-closure glaucoma occurs when the drainage angle of the eye becomes blocked, leading to increased intraocular pressure (IOP). The residual stage indicates that the patient has previously experienced an acute angle-closure attack but now presents with chronic changes. Patients may not exhibit the acute symptoms typical of an initial attack but may still have significant ocular changes.

Signs and Symptoms

1. Visual Symptoms:
   - Blurred Vision: Patients may report persistent blurriness, particularly in low-light conditions.
   - Halos Around Lights: This symptom arises from corneal edema and is common in patients with elevated IOP.

2. Ocular Signs:
   - Elevated Intraocular Pressure: IOP may remain elevated, often above 21 mmHg, even in the absence of acute symptoms.
   - Corneal Edema: Swelling of the cornea can be observed, which may lead to a cloudy appearance.
   - Optic Nerve Changes: Examination may reveal cupping of the optic disc, indicative of optic nerve damage due to prolonged elevated IOP.

3. Systemic Symptoms:
   - Headaches: Patients may experience chronic headaches, often related to the eye condition.
   - Nausea and Vomiting: These symptoms can occur, particularly if the patient has a history of acute attacks.

Patient Characteristics

1. Demographics:
   - Age: Angle-closure glaucoma is more prevalent in older adults, particularly those over 60 years of age.
   - Gender: Women are at a higher risk, likely due to anatomical differences in the eye structure.

2. Anatomical Features:
   - Shallow Anterior Chamber: Patients often have a shallow anterior chamber, which predisposes them to angle closure.
   - Hyperopia (Farsightedness): Individuals with hyperopia are more likely to develop angle-closure glaucoma due to the anatomical configuration of their eyes.

3. Family History:
   - A family history of glaucoma can increase the risk of developing angle-closure glaucoma, indicating a genetic predisposition.

4. Ethnicity:
   - Certain ethnic groups, particularly those of Asian descent, have a higher incidence of angle-closure glaucoma due to anatomical variations in the eye.

Conclusion

The residual stage of angle-closure glaucoma, classified under ICD-10 code H40.24, presents with a unique set of clinical features that differ from the acute phase. Patients may experience chronic visual disturbances, elevated intraocular pressure, and specific ocular signs such as corneal edema and optic nerve changes. Understanding these characteristics is essential for healthcare providers to ensure timely diagnosis and appropriate management of this condition, ultimately aiming to preserve vision and prevent further complications. Regular monitoring and treatment adjustments are crucial for patients in this stage to manage their condition effectively.

The ICD-10 code H40.24 specifically refers to the "Residual stage of angle-closure glaucoma." This classification is part of a broader coding system used to identify various types of glaucoma and their stages. Below are alternative names and related terms associated with this specific code:

Alternative Names for H40.24

1. Chronic Angle-Closure Glaucoma: This term may be used to describe the long-term effects of angle-closure glaucoma, particularly when the acute phase has resolved but residual effects remain.

2. Post-Acute Angle-Closure Glaucoma: This phrase emphasizes the condition following an acute episode of angle-closure glaucoma, highlighting the residual symptoms or damage.

3. End-Stage Angle-Closure Glaucoma: While not an official term, this can be used informally to describe the advanced residual effects of angle-closure glaucoma.

4. Residual Angle-Closure Glaucoma: A straightforward alternative that directly reflects the residual nature of the condition.

Related Terms

1. Angle-Closure Glaucoma: This is the broader category under which H40.24 falls, encompassing all forms of glaucoma caused by the closure of the anterior chamber angle.

2. Primary Angle-Closure Glaucoma: Refers to angle-closure glaucoma that occurs without any identifiable cause, which can lead to residual stages.

3. Secondary Angle-Closure Glaucoma: This term describes angle-closure glaucoma that results from other conditions, which may also lead to residual stages.

4. Glaucoma: A general term for a group of eye conditions that damage the optic nerve, often associated with increased intraocular pressure.

5. Intraocular Pressure (IOP): While not a direct synonym, understanding IOP is crucial in the context of glaucoma, including its residual stages.

6. Visual Field Loss: A common consequence of glaucoma, including its residual stages, which may be referenced in clinical discussions.

Conclusion

Understanding the alternative names and related terms for ICD-10 code H40.24 is essential for accurate diagnosis, treatment, and billing in clinical settings. These terms help healthcare professionals communicate effectively about the condition and its implications for patient care. If you need further information on coding guidelines or management strategies for angle-closure glaucoma, feel free to ask!

The diagnosis of angle-closure glaucoma, particularly the residual stage classified under ICD-10 code H40.24, involves a comprehensive evaluation based on specific clinical criteria. Understanding these criteria is essential for accurate coding and effective management of the condition.

Overview of Angle-Closure Glaucoma

Angle-closure glaucoma occurs when the drainage angle of the eye becomes blocked, leading to increased intraocular pressure (IOP) and potential damage to the optic nerve. The residual stage refers to the condition after an acute episode has been treated, but where some degree of angle closure and visual impairment may still persist.

Diagnostic Criteria for H40.24

1. Clinical History

• Previous Episodes: A documented history of acute angle-closure attacks is crucial. Patients may report symptoms such as severe eye pain, headache, nausea, vomiting, and blurred vision during these episodes.
• Treatment History: Information regarding previous interventions, such as laser peripheral iridotomy or surgical procedures, is important to establish the residual nature of the condition.

2. Intraocular Pressure Measurement

• Elevated IOP: Persistent elevated intraocular pressure is a key indicator. Normal IOP ranges from 10 to 21 mmHg; values above this range may suggest ongoing issues related to angle closure.

3. Gonioscopy

• Angle Assessment: Gonioscopy is performed to evaluate the anterior chamber angle. In the residual stage, the angle may still be narrow or closed, indicating that the drainage pathway is not fully restored.

4. Visual Field Testing

• Field Defects: Visual field tests may reveal defects consistent with glaucoma damage, such as peripheral vision loss. These findings help confirm the diagnosis and assess the extent of damage.

5. Optic Nerve Examination

• Optic Nerve Head Changes: Examination of the optic nerve head for signs of glaucomatous damage, such as cupping or pallor, is essential. These changes can indicate chronic damage resulting from previous angle-closure episodes.

6. Documentation of Residual Symptoms

• Ongoing Symptoms: Patients may experience residual symptoms such as blurred vision or halos around lights, which can be indicative of ongoing issues related to angle closure.

Conclusion

The diagnosis of residual stage angle-closure glaucoma (ICD-10 code H40.24) requires a multifaceted approach that includes a thorough clinical history, measurement of intraocular pressure, gonioscopic evaluation, visual field testing, and optic nerve examination. Accurate diagnosis is critical for appropriate management and to prevent further vision loss. Regular follow-up and monitoring are essential to assess the progression of the disease and the effectiveness of treatment strategies.

Angle-closure glaucoma is a serious condition that can lead to vision loss if not managed appropriately. The ICD-10 code H40.24 specifically refers to the residual stage of angle-closure glaucoma, which indicates that the patient has previously experienced an acute angle-closure attack but may still have some degree of angle closure or related complications. Here’s a detailed overview of standard treatment approaches for this condition.

Understanding Angle-Closure Glaucoma

Angle-closure glaucoma occurs when the drainage angle of the eye becomes blocked, leading to increased intraocular pressure (IOP). This can happen suddenly (acute angle-closure) or gradually (chronic angle-closure). The residual stage indicates that while the acute episode may have been resolved, the patient may still have ongoing issues related to the angle closure.

Treatment Approaches

1. Medications

Medications are often the first line of treatment for managing residual angle-closure glaucoma. The goals are to lower intraocular pressure and manage symptoms. Commonly used medications include:

• Topical Prostaglandin Analogs: These help increase aqueous humor outflow, thereby reducing IOP.
• Beta-Blockers: These decrease aqueous humor production and are often used in combination with other medications.
• Carbonic Anhydrase Inhibitors: These also reduce aqueous humor production.
• Alpha Agonists: These can both decrease aqueous humor production and increase outflow.

2. Laser Treatments

Laser procedures are crucial in managing angle-closure glaucoma, especially in the residual stage:

• Laser Peripheral Iridotomy (LPI): This is the most common procedure, where a small hole is created in the peripheral iris to allow fluid to flow and relieve pressure. It is often performed to prevent future attacks.
• Laser Iridoplasty: This technique is used to stretch the peripheral iris and open the angle, particularly in cases where LPI is not sufficient.

3. Surgical Interventions

In cases where medications and laser treatments are inadequate, surgical options may be considered:

• Trabeculectomy: This surgery creates a new drainage pathway for aqueous humor, effectively lowering IOP.
• Tube Shunt Surgery: A tube is implanted to help drain fluid from the eye, which can be particularly useful in complex cases.

4. Monitoring and Follow-Up

Regular monitoring of IOP and visual field testing is essential for patients with residual angle-closure glaucoma. This helps in assessing the effectiveness of the treatment and making necessary adjustments. Patients should also be educated about the signs of acute angle-closure attacks, such as sudden eye pain, headache, nausea, and blurred vision, so they can seek immediate care if these symptoms occur.

Conclusion

The management of residual angle-closure glaucoma involves a combination of medications, laser treatments, and possibly surgical interventions, tailored to the individual needs of the patient. Regular follow-up is crucial to ensure that intraocular pressure remains controlled and to prevent further complications. As always, patients should work closely with their ophthalmologist to determine the most appropriate treatment plan based on their specific condition and history.