Acute closed-angle glaucoma: an investigation into the effect of delay in treatment

A retrospective study of 212 eyes with acute closed-angle glaucoma is reported. A peak incidence in the sixth decade was noted and an increased incidence in females confirmed statistically. A surprising and often marked delay occurred in the presentation of many patients for treatment, but visual outcome was not influenced by such delay. Despite good control of intraocular pressure, many of the eyes suffered visual loss from optic nerve damage, and the visual outcome was not related to the height of intraocular pressure at presentation. Damage to the visual system occurred very early in the disease, probably with the initial acute rise of intraocular pressure, and eyes appear to vary in their susceptibility to such an insult. It does not appear that earlier presentation of the patient with acute glaucoma would significantly improve the visual outcome in terms of visual acuity. The short critical time before damage occurs to the eyes suggests a role for preventive ophthalmology in the detection and surgery of eyes at risk with shallow anterior chambers and narrow angles before they develop acute closed-angle glaucoma.