title: Pharmacological and environmental factors in primary angle-closure glaucoma.
abstract: BACKGROUND
  A large number of drug classes have now been reported to provoke angle closure in high-risk individuals. The mechanism of action can be generalized into three main categories: sympathomimetic, parasympatholytic and idiosyndratic reactions.
  
  
  METHODS
  This review of the ophthalmic literature provides a clinical summary of primary angle-closure glaucoma (PACG) and its management.
  
  
  RESULTS
  External stimuli (pharmacological and environmental) may induce acute, and more often, asymptomatic angle closure, which carries a significant risk of glaucoma.
  
  
  CONCLUSIONS
  Whenever in doubt, patients at risk of PACG who are starting on drug therapy known to provoke angle closure or aggravate the condition should be referred for detailed gonioscopic examination of the anterior chamber by an ophthalmologist. AREAS FOR DEVELOPING RESEARCH: The use of new imaging methods such as anterior segment optical coherence tomography to assess the presence or risk of angle closure is gaining popularity, and may offer a more rapid method of identifying people who are at risk of sight loss from angle-closure glaucoma precipitated by non-ophthalmological medication.
authors.affiliation: Moorfields Eye Hospital, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Subak-Sharpe
authors.forename: Sancy
authors.initials: S
authors.lastname: Low
authors.forename: Winifred
authors.initials: W
authors.lastname: Nolan
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Foster
mesh_terms: D015812:Glaucoma, Angle-Closure / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D012307:Risk Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D014794:Visual Fields