ICD-10: H40.241

Angle-closure glaucoma is a serious ocular condition characterized by a sudden increase in intraocular pressure (IOP) due to the obstruction of the aqueous humor outflow. The ICD-10 code H40.241 specifically refers to the residual stage of angle-closure glaucoma in the right eye. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for effective diagnosis and management.

Clinical Presentation

Definition and Stages

Residual stage angle-closure glaucoma occurs after an acute angle-closure attack has been treated but may still present with ongoing symptoms or complications. This stage indicates that while the immediate crisis has been managed, the patient may still experience residual effects from the previous episodes of elevated IOP and potential optic nerve damage.

Patient Characteristics

Patients with residual angle-closure glaucoma often share certain characteristics:
- Age: Typically affects older adults, particularly those over 60 years of age.
- Gender: More prevalent in females than males, possibly due to anatomical differences in the eye.
- Ethnicity: Higher incidence in certain populations, such as East Asian individuals, due to anatomical predispositions.

Signs and Symptoms

Common Symptoms

Patients may report a variety of symptoms, which can include:
- Visual Disturbances: Blurred vision or halos around lights, particularly in low-light conditions.
- Eye Pain: Discomfort or pain in the affected eye, which may be intermittent or persistent.
- Headaches: Often localized around the eye or forehead, which can be severe.
- Nausea and Vomiting: These systemic symptoms may occur during acute episodes but can persist in the residual stage.

Clinical Signs

Upon examination, healthcare providers may observe:
- Elevated Intraocular Pressure: Persistent IOP readings above the normal range (10-21 mmHg), indicating ongoing glaucoma.
- Optic Nerve Changes: Signs of damage or cupping of the optic nerve head, which can be assessed through fundoscopic examination.
- Corneal Edema: Swelling of the cornea may be present, particularly if there was a recent acute attack.
- Pupil Reaction: The affected eye may exhibit a mid-dilated pupil that does not respond well to light.

Additional Findings

• Visual Field Defects: Testing may reveal peripheral vision loss, which is common in glaucoma patients.
• Anterior Chamber Depth: Shallow anterior chamber depth can be noted, contributing to the risk of angle closure.

Conclusion

The residual stage of angle-closure glaucoma (ICD-10 code H40.241) presents a unique set of challenges for both patients and healthcare providers. Recognizing the clinical signs and symptoms, along with understanding patient characteristics, is essential for ongoing management and prevention of further complications. Regular monitoring of intraocular pressure and visual function is critical in these patients to mitigate the risk of progressive optic nerve damage and preserve vision. Early intervention and appropriate treatment strategies can significantly improve patient outcomes in this condition.

ICD-10 code H40.241 refers specifically to the residual stage of angle-closure glaucoma in the right eye. This classification is part of a broader system used to categorize various types of glaucoma and their stages. Below are alternative names and related terms associated with this specific code.

Alternative Names for H40.241

1. Residual Angle-Closure Glaucoma: This term emphasizes the condition's status as a lingering or remaining stage of angle-closure glaucoma.
2. Chronic Angle-Closure Glaucoma: While not a direct synonym, this term can sometimes be used to describe ongoing issues stemming from previous angle-closure episodes.
3. Post-Acute Angle-Closure Glaucoma: This term may be used to describe the condition following an acute episode of angle-closure glaucoma that has not fully resolved.

Related Terms

1. Angle-Closure Glaucoma: A broader category that includes all forms of glaucoma caused by the closure of the angle between the iris and cornea, which can lead to increased intraocular pressure.
2. Primary Angle-Closure Glaucoma: Refers to angle-closure glaucoma that occurs without any identifiable cause, often linked to anatomical predispositions.
3. Secondary Angle-Closure Glaucoma: This term describes angle-closure glaucoma that arises due to other conditions, such as inflammation or tumors.
4. Intraocular Pressure (IOP): A critical measurement in glaucoma management, often elevated in cases of angle-closure glaucoma.
5. Visual Field Loss: A common consequence of untreated or poorly managed glaucoma, including angle-closure types.

Clinical Context

Understanding these terms is essential for healthcare professionals involved in diagnosing and treating glaucoma. The residual stage of angle-closure glaucoma indicates that while the acute phase may have passed, the patient may still experience complications or require ongoing management to prevent further vision loss.

In clinical practice, accurate coding and terminology are crucial for effective communication among healthcare providers and for proper billing and insurance purposes. The use of these alternative names and related terms can help ensure clarity in patient records and treatment plans.

In summary, H40.241 is a specific code that reflects a particular stage of angle-closure glaucoma, and familiarity with its alternative names and related terms can enhance understanding and communication in clinical settings.

The diagnosis of angle-closure glaucoma, particularly in its residual stage as indicated by the ICD-10 code H40.241, involves a comprehensive evaluation of clinical findings and patient history. Below are the key criteria and considerations used in diagnosing 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) and potential damage to the optic nerve. The residual stage refers to the condition after an acute episode has been resolved but may still exhibit some ongoing effects or damage.

Diagnostic Criteria

1. Clinical History

• Previous Episodes: A history of acute angle-closure attacks is crucial. Patients may report symptoms such as severe eye pain, headache, nausea, vomiting, and visual disturbances during these episodes.
• Treatment History: Information about previous treatments, including medications or surgical interventions, is essential to understand the progression of the disease.

2. Symptoms

• Patients may experience ongoing symptoms such as blurred vision, halos around lights, or difficulty adjusting to changes in lighting, which can indicate residual effects of angle-closure glaucoma.

3. Intraocular Pressure Measurement

• Elevated IOP: Measurement of IOP is critical. In angle-closure glaucoma, IOP is often elevated, and in the residual stage, it may still be higher than normal, although not as high as during an acute attack.

4. Gonioscopy

• Angle Assessment: Gonioscopy is a specialized examination that allows the clinician to visualize the anterior chamber angle. In the residual stage, the angle may be closed or partially open, indicating previous closure.

5. Optic Nerve Assessment

• Optic Nerve Damage: Evaluation of the optic nerve head for signs of damage, such as cupping or pallor, is essential. This assessment helps determine the extent of glaucomatous damage.

6. Visual Field Testing

• Field Loss: Visual field tests can reveal peripheral vision loss, which is common in glaucoma. In the residual stage, there may be evidence of previous damage even if the patient does not currently experience significant symptoms.

7. Additional Imaging

• OCT (Optical Coherence Tomography): This imaging technique can provide detailed information about the retinal nerve fiber layer and help assess any structural changes due to glaucoma.

Conclusion

The diagnosis of H40.241, or residual stage of angle-closure glaucoma in the right eye, requires a multifaceted approach that includes a thorough clinical history, symptom assessment, intraocular pressure measurement, gonioscopy, optic nerve evaluation, visual field testing, and possibly advanced imaging techniques. Each of these components plays a vital role in confirming the diagnosis and determining the appropriate management strategy for the patient. Regular follow-up and monitoring are essential to prevent further progression of the disease and to manage any residual effects effectively.

The management of angle-closure glaucoma, particularly in its residual stage as indicated by ICD-10 code H40.241, involves a combination of medical, surgical, and laser treatments aimed at controlling intraocular pressure (IOP) and preventing further vision loss. Below is a detailed overview of standard treatment approaches for this condition.

Understanding Residual Stage of Angle-Closure Glaucoma

Angle-closure glaucoma occurs when the drainage angle of the eye becomes blocked, leading to a rapid increase in intraocular pressure. The residual stage indicates that the patient has previously experienced an acute angle-closure attack, and while the immediate crisis may have been resolved, the risk of future episodes and ongoing pressure issues remains.

Medical Management

1. Medications

• Topical Prostaglandin Analogs: These medications, such as latanoprost and bimatoprost, help to increase aqueous humor outflow, thereby reducing IOP.
• Beta-Blockers: Drugs like timolol can decrease aqueous humor production, contributing to lower IOP.
• Carbonic Anhydrase Inhibitors: Medications such as dorzolamide can also reduce aqueous humor production.
• Alpha Agonists: Brimonidine is another option that can help lower IOP by both decreasing aqueous humor production and increasing outflow.

2. Oral Medications

• Carbonic Anhydrase Inhibitors: Acetazolamide can be used in acute settings to rapidly lower IOP.
• Osmotic Agents: Mannitol may be administered in acute situations to draw fluid out of the eye and reduce pressure quickly.

Surgical and Laser Interventions

1. Laser Peripheral Iridotomy (LPI)

• This is often the first-line surgical treatment for angle-closure glaucoma. LPI creates a small hole in the peripheral iris, allowing aqueous humor to flow freely and reducing the risk of future angle closure. It is particularly effective in preventing acute attacks and is a critical step in managing residual angle-closure glaucoma.

2. Goniotomy or Iridectomy

• In cases where LPI is not sufficient, a goniotomy (surgical opening of the drainage angle) or an iridectomy (removal of a portion of the iris) may be performed to enhance aqueous outflow.

3. Aqueous Shunts

• For patients with persistent high IOP despite medical therapy and laser treatment, aqueous shunt devices may be implanted to facilitate fluid drainage from the eye.

4. Trabeculectomy

• This surgical procedure creates a new drainage pathway for aqueous humor, effectively lowering IOP. It is typically reserved for more advanced cases or when other treatments have failed.

Follow-Up and Monitoring

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

Conclusion

The management of residual stage angle-closure glaucoma (ICD-10 code H40.241) requires a comprehensive approach that includes both medical and surgical strategies. Early intervention with laser procedures like LPI is critical to prevent further complications, while ongoing medical therapy helps maintain IOP within a safe range. Regular monitoring and individualized treatment plans are essential to preserve vision and enhance the quality of life for affected patients.

ICD-10 code H40.241 refers to the "Residual stage of angle-closure glaucoma, right eye." This classification is part of the broader category of glaucoma, which encompasses various types of this eye condition characterized by increased intraocular pressure (IOP) that can lead to optic nerve damage and vision loss.

Clinical Description of Angle-Closure Glaucoma

Definition

Angle-closure glaucoma occurs when the drainage angle of the eye becomes blocked, preventing aqueous humor from exiting the eye. This blockage can lead to a rapid increase in intraocular pressure, resulting in acute symptoms and potential vision loss if not treated promptly. The "residual stage" indicates that the patient has previously experienced an episode of angle-closure glaucoma, but the acute phase has resolved, leaving behind chronic changes or damage.

Symptoms

Patients with angle-closure glaucoma may experience:
- Severe eye pain
- Headaches
- Nausea and vomiting
- Blurred vision
- Halos around lights
- Redness of the eye

In the residual stage, symptoms may be less acute but can include persistent visual disturbances or discomfort.

Diagnosis and Management

Diagnosis

Diagnosis of angle-closure glaucoma typically involves:
- Tonometry: Measuring intraocular pressure.
- Gonioscopy: Examining the drainage angle of the eye to assess its openness or closure.
- Visual field testing: Evaluating peripheral vision loss, which can indicate optic nerve damage.

Management

Management strategies for residual angle-closure glaucoma may include:
- Medications: To lower intraocular pressure, such as topical beta-blockers, prostaglandin analogs, or carbonic anhydrase inhibitors.
- Laser therapy: Procedures like laser peripheral iridotomy or laser iridoplasty may be performed to create a new drainage pathway.
- Surgical intervention: In some cases, surgical options may be necessary to manage the condition effectively.

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. Regular monitoring and treatment are crucial to prevent further vision loss.

Conclusion

ICD-10 code H40.241 captures the complexities of managing residual angle-closure glaucoma in the right eye. Understanding the clinical implications, diagnostic criteria, and treatment options is essential for healthcare providers to ensure optimal patient outcomes. Regular follow-up and adherence to treatment plans are vital in managing this chronic condition effectively.