[Pathogenesis and treatment of primary closed-angle glaucoma].

With an incidence of about 1/1000, primary angle-closure glaucoma is 4 to 5 times less frequent than primary open-angle glaucoma. It occurs most frequently due to pupillary block, itself both due to anatomical configuration and to either physiological or pathological changes in the anterior chamber. Pupillary block causes an increase of pressure in the posterior chamber, which leads to anterior displacement of the iris and, finally, to angle closure. The treatment of choice - dictated by the pathogenesis - consists of diminishing the posterior chamber pressure by means of hyperosmotic agents such as glycerin per os or mannitol iv. After reduction of the posterior-chamber pressure has been attained, a mild miotic, i.e. one which causes neither a strong miosis nor a flattening of the anterior chamber, is administered. If it is an acute attack, the application of these principles will permit normalization of pressure within about one hour. Several therapeutic guidelines are proposed, adapted to certain classical situations as well as to some less classical.