Pathogenesis and Natural History

Eyes that are predisposed to develop closed-angle glaucoma generally have a shallow anterior chamber and are often hypermetropic. There is forward bowing of the iris, which is more evident in these individuals, and the corneal diameter is slightly smaller than in normal eyes. Another factor is the gradual,but slight,increase in size of the lens, which takes place with ageing. Raised intraocular pressure in angle closure is caused by occlusion of the angle by the iris root and it can be precipitated by dilating the pupil. An uncontrolled acute attack of glaucoma can lead to rapid and permanent loss of the sight of the affected eye. Although it is known that occasionally patients recover spontaneously from such an attack, they could be left with chronic angle closure and a picture similar to that of chronic open-angle glaucoma. About half the patients with closed-angle glaucoma will develop a similar problem in the other eye if steps are not taken to prevent this, and it will be seen that prophylactic treatment for the other eye is now the rule.

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