ICD-10: H40.249

Angle-closure glaucoma is a serious condition that can lead to vision loss if not treated promptly. The ICD-10 code H40.249 specifically refers to the residual stage of angle-closure glaucoma in an unspecified eye. This stage indicates that the patient has previously experienced an acute angle-closure episode, which may have been treated, but the eye remains at risk for further 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 develop gradually (chronic angle-closure). The residual stage indicates that while the acute episode may have been managed, the patient may still experience symptoms or complications related to the condition.

Standard Treatment Approaches

1. Medications

Medications are often the first line of treatment for managing IOP in patients with residual angle-closure glaucoma. Common classes of medications include:

• Prostaglandin Analogues: These help increase the outflow of aqueous humor, thereby reducing IOP. Examples include latanoprost and bimatoprost.
• Beta-Blockers: These reduce the production of aqueous humor. Timolol is a commonly used beta-blocker.
• Alpha Agonists: These also decrease aqueous humor production and increase outflow. Brimonidine is an example.
• Carbonic Anhydrase Inhibitors: These medications, such as dorzolamide, help reduce aqueous humor production.
• Oral Medications: In some cases, oral carbonic anhydrase inhibitors like acetazolamide may be prescribed for more significant IOP reduction.

2. Laser Treatments

Laser therapy is a critical component in the management of angle-closure glaucoma, especially in the residual stage:

• Laser Peripheral Iridotomy (LPI): This procedure creates a small hole in the peripheral iris, allowing aqueous humor to flow freely and reducing IOP. It is often performed as a preventive measure after an acute attack.
• Laser Iridoplasty: This technique is used to reshape the peripheral iris to widen the drainage angle, which can be beneficial in certain cases.

3. Surgical Interventions

If medications and laser treatments are insufficient to control IOP, surgical options may be considered:

• Trabeculectomy: This surgical procedure creates a new drainage pathway for aqueous humor, effectively lowering IOP.
• Aqueous Shunts: Devices such as Ahmed or Baerveldt shunts can be implanted to facilitate fluid drainage from the eye.
• Goniotomy or Trabeculotomy: These procedures involve incising the trabecular meshwork to improve drainage.

4. Regular Monitoring and Follow-Up

Patients with a history of angle-closure glaucoma require regular monitoring to assess IOP and the health of the optic nerve. This may include:

• Visual Field Testing: To evaluate peripheral vision and detect any loss due to glaucoma.
• Optic Nerve Imaging: Techniques such as optical coherence tomography (OCT) can help monitor changes in the optic nerve head.

Conclusion

The management of residual angle-closure glaucoma (ICD-10 code H40.249) involves a combination of medications, laser treatments, and possibly surgical interventions, tailored to the individual patient's needs. Regular follow-up is essential to monitor the condition and prevent further complications. Patients should work closely with their ophthalmologist to determine the most appropriate treatment plan based on their specific circumstances and the severity of their condition.

The clinical presentation of angle-closure glaucoma, particularly in its residual stage as classified under ICD-10 code H40.249, involves a range of signs, symptoms, and patient characteristics that are crucial for diagnosis and management. Below is a detailed overview of these aspects.

Clinical Presentation

Signs and Symptoms

1. Visual Disturbances: Patients may experience blurred vision or halos around lights, particularly in low-light conditions. This is often due to corneal edema or changes in the lens[1].

2. Eye Pain: Acute episodes of angle-closure glaucoma are typically associated with severe eye pain, but in the residual stage, this pain may be less intense or intermittent. Patients might report discomfort rather than acute pain[2].

3. Headaches: Patients may experience headaches, which can be localized around the eyes or more generalized. These headaches can be chronic and may worsen with eye strain[3].

4. Nausea and Vomiting: In some cases, patients may experience nausea or vomiting, particularly during acute attacks, but this can persist in the residual stage due to ongoing discomfort or anxiety related to vision changes[4].

5. Redness of the Eye: There may be conjunctival injection (redness) due to increased intraocular pressure or inflammation[5].

6. Pupil Changes: The affected eye may exhibit a mid-dilated, non-reactive pupil, which is a hallmark of angle-closure glaucoma. In the residual stage, the pupil may not return to its normal size or reactivity[6].

Patient Characteristics

1. Age: Angle-closure glaucoma is more prevalent in older adults, particularly those over the age of 60. The risk increases with age due to anatomical changes in the eye[7].

2. Gender: Women are at a higher risk for angle-closure glaucoma compared to men, likely due to anatomical differences in the eye structure and hormonal factors[8].

3. Ethnicity: Certain ethnic groups, particularly those of Asian descent, have a higher prevalence of angle-closure glaucoma due to anatomical predispositions such as a shallower anterior chamber[9].

4. Family History: A family history of glaucoma can increase the risk of developing angle-closure glaucoma, indicating a genetic predisposition[10].

5. Pre-existing Conditions: Patients with hyperopia (farsightedness) are at greater risk due to the anatomical configuration of their eyes, which can predispose them to angle-closure episodes[11].

6. Previous Eye Surgery: Individuals who have undergone cataract surgery or other ocular procedures may have altered anatomy that increases the risk of angle-closure glaucoma[12].

Conclusion

The residual stage of angle-closure glaucoma (ICD-10 code H40.249) presents with a unique set of signs and symptoms that can significantly impact a patient's quality of life. Understanding these clinical features, along with the patient characteristics that predispose individuals to this condition, is essential for timely diagnosis and effective management. Regular eye examinations and monitoring are crucial for patients at risk, particularly those with a history of angle-closure episodes or other risk factors. Early intervention can help prevent further vision loss and improve overall outcomes for affected individuals.

The ICD-10 code H40.249 refers specifically to the "Residual stage of angle-closure glaucoma, unspecified eye." This classification is part of the broader category of glaucoma diagnoses, which are essential for accurate medical billing and coding in ophthalmology. Below are alternative names and related terms associated with this specific code.

Alternative Names for H40.249

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 an exact synonym, this term can sometimes be used to describe ongoing issues related to angle-closure glaucoma.
3. Unspecified Angle-Closure Glaucoma: This term highlights the lack of specification regarding which eye is affected, aligning with the "unspecified eye" designation in H40.249.

Related Terms

1. Angle-Closure Glaucoma: This is the broader category under which H40.249 falls, encompassing all stages of angle-closure glaucoma.
2. Primary Angle-Closure Glaucoma: This term refers to the initial onset of angle-closure glaucoma, which may progress to a residual stage.
3. Secondary Angle-Closure Glaucoma: This term describes angle-closure glaucoma that arises due to other conditions, which may also lead to a residual stage.
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, IOP is a critical factor in the diagnosis and management of all types of glaucoma, including angle-closure variants.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals involved in the diagnosis, treatment, and coding of glaucoma. Accurate coding ensures proper reimbursement and facilitates effective communication among healthcare providers. The residual stage of angle-closure glaucoma indicates that the patient may have ongoing issues related to the condition, even if the acute phase has resolved.

In summary, H40.249 is a specific code that can be described using various alternative names and related terms, all of which are important for clinical documentation and billing purposes in ophthalmology.

The diagnosis of angle-closure glaucoma, particularly in its residual stage as indicated by the ICD-10 code H40.249, 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 current state 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 intraocular pressure is critical. In angle-closure glaucoma, IOP may be elevated, although in the residual stage, it may be normal or only mildly elevated.

4. Gonioscopy

• Angle Assessment: Gonioscopy is performed to evaluate the anterior chamber angle. In the residual stage, the angle may be closed or partially open, indicating previous closure.

5. Visual Field Testing

• Field Defects: Visual field tests can reveal defects consistent with glaucoma damage, which may persist even after the acute phase has resolved.

6. Optic Nerve Examination

• Optic Nerve Head Changes: Examination of the optic nerve head for cupping or other changes indicative of glaucoma is essential. These changes can help confirm the diagnosis and assess the extent of damage.

7. Pachymetry

• Corneal Thickness Measurement: Corneal pachymetry may be used to measure corneal thickness, as this can influence IOP readings and overall glaucoma risk.

Conclusion

The diagnosis of H40.249, or residual stage of angle-closure glaucoma, is multifaceted, relying on a combination of patient history, clinical symptoms, intraocular pressure measurements, gonioscopy, visual field testing, and optic nerve examination. 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 manage the condition effectively and prevent further vision loss.

Clinical Description of ICD-10 Code H40.249

ICD-10 Code H40.249 refers to the residual stage of angle-closure glaucoma in an unspecified eye. This classification is part of the broader category of glaucoma, which is a group of eye conditions that can lead to damage to the optic nerve, often associated with increased intraocular pressure (IOP). Angle-closure glaucoma occurs when the drainage angle of the eye becomes blocked, leading to a rapid increase in IOP, which can result in vision loss if not treated promptly.

Understanding Angle-Closure Glaucoma

Angle-closure glaucoma can be classified into two main stages:

1. Acute Angle-Closure Glaucoma: This is a medical emergency characterized by a sudden rise in IOP, often accompanied by symptoms such as severe eye pain, headache, nausea, vomiting, blurred vision, and seeing halos around lights. It requires immediate treatment to prevent permanent vision loss.

2. Residual Stage: After an acute episode, some patients may enter a residual stage where the acute symptoms have subsided, but the eye may still exhibit signs of damage or changes due to the previous episodes of increased IOP. This stage is classified under H40.249, indicating that while the acute phase has resolved, the patient may still experience ongoing issues related to the condition.

Clinical Features

• Symptoms: Patients in the residual stage may not exhibit acute symptoms but could experience chronic issues such as mild discomfort, fluctuating vision, or peripheral vision loss. Regular monitoring is essential to assess the health of the optic nerve and the overall condition of the eye.

• Diagnosis: Diagnosis typically involves a comprehensive eye examination, including:

• Tonometry: To measure intraocular pressure.
• Gonioscopy: To examine the drainage angle of the eye.
• Visual Field Testing: To assess any loss of peripheral vision.

• Optic Nerve Imaging: To evaluate the health of the optic nerve.

• Management: Treatment options may include:

• Medications: To lower IOP, 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 Options: In some cases, surgical intervention may be necessary to manage the condition effectively.

Importance of Monitoring

Patients diagnosed with H40.249 require ongoing monitoring to prevent progression of the disease and to manage any potential complications. Regular follow-ups with an ophthalmologist are crucial to ensure that any changes in the condition are addressed promptly.

Conclusion

ICD-10 code H40.249 captures the residual stage of angle-closure glaucoma in an unspecified eye, highlighting the importance of continued care and monitoring after an acute episode. Understanding the clinical features, diagnostic methods, and management strategies is essential for healthcare providers to ensure optimal outcomes for patients affected by this condition. Regular assessments can help mitigate the risk of further complications and preserve vision.