Primary Angle Closure Disease Spectrum (PACS / PAC / PACG)
ISGEO consensus continuum of primary angle closure disease (Foster 2002, EAGLE 2016). Distinguishes occludable angles (PACS) from those with PAS or elevated IOP (PAC) and from established glaucomatous neuropathy (PACG). Critical for laser-iridotomy and lens-extraction decisions.
Score interpretation
→ Observation with periodic gonioscopy is reasonable: in the ZAP trial (Lancet 2019) few suspects progressed and prophylactic laser peripheral iridotomy was not recommended routinely. Consider laser iridotomy if the fellow eye has had an acute attack, or if follow-up is unreliable or repeated dilation is needed.
→ Laser peripheral iridotomy, or clear-lens extraction first-line in people aged 50 or over with IOP of 30 mmHg or more (EAGLE, Lancet 2016). Topical IOP-lowering as needed; gonioscopy follow-up.
→ Lens extraction first-line in people aged 50 or over (EAGLE, Lancet 2016). Topical IOP-lowering pre-op. Trabeculectomy + MMC if IOP remains uncontrolled; goniosynechialysis at the time of phaco for fresh PAS. Lifelong glaucoma surveillance.
→ Same-hour ophthalmology; lie the patient supine. Adults: pilocarpine 2% drops to the affected eye (and to the fellow eye as prophylaxis); topical timolol + apraclonidine + dexamethasone; oral acetazolamide 500 mg (or IV if vomiting); IV mannitol 1–1.5 g/kg if IOP not falling. Children: use a children's formulary. Definitive YAG PI to both eyes once cornea clears, or early lens extraction. Antiemetics, analgesia.
Interpretation bands for the Angle Closure. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
- Zinc acetate · Zinc salt (Wilson's disease)
- Sulfasalazine · Aminosalicylate / Disease-Modifying Antirheumatic Drug (DMARD)
- Obeticholic Acid · FXR Agonist (Primary Biliary Cholangitis)
- Hydroxycarbamide (Hydroxyurea) · Cytoreductive agent / Sickle cell disease / CML
- Acute Red Eye / Vision Loss Screen · RCOphth 2020; NICE CKS
- Idiopathic Intracranial Hypertension · ABN; consensus 2018
- Acute Red Eye Assessment · RCOphth / AAO
- Acute Angle Closure Glaucoma · RCOphth / EGS Guidelines
- Retinal Detachment · RCOphth Guidelines / EURETINA
- Diabetic Retinopathy — Screening and Management · NICE NG28 2016 / NHS DES Programme
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.