Primary angle-closure is the synechial or appositional closure of the anterior chamber angle secondary to multiple mechanisms resulting in raised intraocular pressure and structural changes in the eyes.
Iridotrabecular contact is the hallmark of primary angle-closure and the most commonly identified sign which indicates that treatment is required.
It is defined by at least 180 degrees of iridotrabecular contact together with an elevated intraocular pressure or peripheral anterior synechiae or btoh
Primary angle-closure glaucoma is the presence of glaucomatous optic neuropathy.
Instruct patients to avoid medicines that cause pupillary dilatation and induce an acute angle-closure crisis (eg decongestants, adrenergic agents, anticholinergics, antipsychotics, antidepressants, motion sickness medications)
Teach patients on how to properly instill eye drops (intervals, lid closure, punctal occlusion)
Punctal occlusion and eyelid closure for at least 3 minutes
If ≥2 drops are to be instilled, wait at least 5 minutes between drops
Demonstrate the preferred method and ensure patient can do it
Communicate to the patient and family the importance of compliance since glaucoma is a chronic disease which requires continuous patient cooperation for successful management
Advise patients with family history of PAC to undergo regular eye screening examinations for this condition
Inform patients at risk for acute angle-closure about its symptoms and instruct them to notify immediately should these symptoms occur
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