Primary angle closure is common in Indian and other Asian populations and is easily mislabelled as open-angle glaucoma when the angle is not examined. Gonioscopy, preferably indentation gonioscopy in a dark room with a short, narrow beam, distinguishes appositional from synechial closure and changes the treatment plan: laser iridotomy, lens extraction or angle surgery rather than drops alone.
- Perform gonioscopy at diagnosis in every patient with glaucoma.
- Use dim light and a narrow beam to avoid opening the angle artificially.
- Use indentation to separate appositional from synechial closure.
- Repeat gonioscopy when IOP rises unexpectedly.
Why it matters
Missed angle closure leads to the wrong treatment for years.
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