Management of patients with narrow angles and acute angle-closure glaucoma

BACKGROUND: Acute closure of the anterior chamber angle can have catastrophic consequences for vision when it occurs in an unsupervised situation. Visual debilitation is much less likely to result when angle-closure occurs in a well-controlled environment that allows appropriate management. Therefore, it is desirable for optometrists to undertake a complete ocular health assessment, including mydriatic fundus examination, on patients who have narrow anterior chamber angles, provided that appropriate precautions and procedures are followed. CASE REPORT: We report on the case of a 59-year-old white female whose anterior chamber angles closed in response to mydriatic drops instilled during an optometric examination. Her optic discs and visual field results from before and four years after the angle-closure attack do not show any significant changes. CONCLUSION: We conclude that the optimal standard of care for patients presenting to an optometric practice, and who are subsequently found to have narrow anterior chamber angles, includes pupillary dilatation to allow stereoscopic visualisation of the optic nerve head. Precautions must be followed to ensure that, in the unlikely event of an ensuing angle-closure episode, the attack occurs under clinically supervised conditions.