Primary Angle-Closure Glaucoma

In primary angle-closure glaucoma, which anatomical feature is MOST significant in predisposing to angle closure?

A 58-year-old woman from Delhi presents to the emergency department with acute onset severe eye pain, blurred vision, and nausea for the past 6 hours. On examination, the right eye shows mid-dilated pupil, corneal edema, conjunctival injection, and intraocular pressure (IOP) of 58 mmHg. Gonioscopy reveals appositional angle closure. The left eye is anatomically predisposed but currently asymptomatic with normal IOP. What is the most appropriate immediate next step in management?

A 58-year-old hyperopic woman from Delhi presents to the emergency department with sudden onset of severe left eye pain, blurred vision, and nausea for the past 4 hours. She reports seeing halos around lights. On examination, the left eye shows corneal edema, mid-dilated pupil (5 mm), and intraocular pressure of 58 mmHg. Gonioscopy reveals an occluded angle. The right eye appears normal with IOP 16 mmHg and open angles on gonioscopy. What is the most appropriate immediate management?

A 62-year-old woman from Bangalore with a history of hyperopia and shallow anterior chamber presents with her right eye having been treated for acute angle-closure glaucoma 6 months ago with Nd:YAG laser peripheral iridotomy. She now reports gradual dimming of vision in the left eye over 3 weeks with occasional mild discomfort. Examination of the left eye reveals: visual acuity 6/12, IOP 24 mmHg, anterior chamber depth 2.0 mm, and gonioscopy shows a narrow angle (Shaffer grade 1) with the angle not yet occluded. What is the most appropriate management for the left eye?

A 62-year-old man from Mumbai with a history of hyperopia and thick lens presents with intermittent episodes of blurred vision and mild eye discomfort over the past 2 weeks. On examination, the anterior chamber is shallow, and gonioscopy shows appositional angle closure in the superior and temporal quadrants without any synechiae. Intraocular pressure is 22 mmHg in both eyes. Anterior segment OCT confirms narrow angles bilaterally. What is the most appropriate next step in management?