Foster Classification and GPAC Clinical Picture
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ScribdTranslationsFoster Classification and GPAC Clinical Picture
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ScribdTranslationsClassification based on the evolution of the disease
This classification suggests a continuum of the disease, in which the angle closure process
and that of glaucomatous optic neuropathy represent associated alterations. Thus, the term
"glaucoma" is restricted to individuals who present with optic nerve damage.
• Suspicion of primary angular closure
Term used for the individual at risk of suffering from primary angle closure.
The identification of this condition is based on the inability to observe, at gonioscopy, the
pigmented portion of the trabecular meshwork at 180 or more, without complementary maneuvers, in
primary position of the gaze, in a dark environment, with a narrow light slot and without
to illuminate the pupil to prevent the opening of the angle. There are no pigmentary remnants of
previous iridotrabecular placement (imprint), goniosynechiae, or glaucomatous optic neuropathy,
and the levels of IOP are within the limits of normality.
• Primary angular closure
It is the term used when the individual already shows signs of the angular closure process.
primary.
In this condition, in addition to the gonioscopic alterations observed in individuals with
suspects of angle closure, show imprint or goniosynchia and/or increase in IOP.
However, there is no glaucomatous optic neuropathy.
The evolution of the "suspected angle closure" to the "primary angle closure" can occur.
in the presence or absence of symptoms.
Comment: the term "acute glaucoma" was replaced by the term "angle closure"
acute primary". This clinical presentation represents the most symptomatic form of the process of
angular closure, in which the filtering trabeculation is abruptly obstructed by the periphery
of the iris, which leads to a sharp increase in IOP and the characteristic symptoms. In the current
classification, the term 'glaucoma' is restricted to eyes that already show signs of neuropathy
glaucomatous optic nerve. The eyes that show sequelae of this acute clinical picture but without
Signs of glaucomatous neuropathy are characterized as eyes with 'acute angle closure'
primary." On the other hand, eyes with sequelae of primary acute angle closure and signs of
glaucomatous neuropathy is classified as "primary angle-closure glaucoma with
previous episodes of primary acute angle closure.
Note: The term "acute glaucoma" may remain in consensus during this period of
transition.
• Primary Closed-Angle Glaucoma
This condition is characterized by the alterations found in individuals with closure
primary angle, associated with the presence of glaucomatous optic neuropathy and/or defect
campimetric compatible with glaucoma.
Classification of the angular closure process by symptoms
The process of angular closure can manifest through three clinical forms: acute,
intermittent and chronic
Acute shape
More aggressive/symptomatic clinical manifestation of the angle closure process, generally
unilateral.
Symptoms:
• Intense eye pain
• Headache, in general, hemicrania and ipsilateral
• Blurred vision
• Vision of color halos
• Nausea and vomiting
Signs:
• High PIO, often above 40 mmHg
• Reduction of visual acuity
• Corneal edema, predominantly epithelial
• Midriasis media paralytica or hyporeactive pupil
• Previous flat camera
• Peripheral bulging of the iris (iris bombé)
• Angular closure generally at 360 or
• Conjunctival hyperemia with ciliary injection
• Tyndall inflammatory and/or pigmentary
NOTE: The optical disc may show edema, with venous congestion and/or hemorrhage in
candle flame associated.
Intermittent form
Clinical picture similar to that of the acute form, but with milder manifestations.
recurrent, which resolve spontaneously.
Symptoms
• Vision of halos, eye pain and/or mild ipsilateral headache at the time of the crisis
Signs:
• PIO elevated during crises, but normal between crises
• Imprint
• Presence or absence of goniosynchia
• Previous flat camera
• Chronic form
They represent the cases in which the angular closure process occurs asymptomatically.
Note: this classification refers to symptomatology and not to the duration of
disease.
Symptoms:
• Absent
Signs:
• high or normal PIO
• Presence or absence of goniosynchia
• Possible concomitance of intermittent or acute angle closure
• Flat front camera
Comments: In the different clinical presentations based on the symptoms, one can
observe or not glaucomatous optic neuropathy. The presence of the lesion in the optic nerve
It depends on individual susceptibility and the duration and intensity of elevated IOP.
the patient may migrate from one category to another over time, depending on the evolution of
the anatomical alterations and/or interventions performed. Ex: Patient with the chronic form
that eventually develops an acute angle closure, or a patient with the acute form that,
Even after the iridectomy, it becomes chronic.
Clinical assessment
The detection of patients at risk of primary angle closure should be carried out through the
biomicroscopic evaluation of the central and peripheral anterior chamber.
In patients with suspected primary angle closure, the ophthalmological examination should
include refraction, applanation tonometry, and anterior segment biomicroscopy
posterior.
