Exfoliation syndrome (XFS) is an age-related multifactorial, progressive, disorder, characterized by the excessive production of an extracellular material that results in white fibrillar deposits in many ocular tissues, significantly on the anterior lens surface and pupillary margin.

Ocular hypotony can be defined as an intraocular pressure (IOP) less than 6 mmHg, which corresponds to more than three standard deviations below the mean. However, not all cases will develop symptoms with an IOP of 6 mmHg or less, while some eyes will develop symptoms even above this IOP. Patients may develop symptoms depending on scleral rigidity, axial length, lid pressure and eye rubbing.3 Therefore, hypotony should be defined as low pressure (whether acute, transient, chronic or permanent) which, in an individual eye, leads to functional and/or structural changes.

Postoperative hypotony can be divided into early (occurring within 4 weeks of surgery) and late (occurring more than 4 weeks after surgery).

Here, you will learn about the Approach to Primary Angle Closure Suspect (PACS) and Primary Angle Closure (PAC). You can go to each of these topics by clicking on the menu, and enlarge on the information given whenever you find ⁺, or find the Reference for the information given whenever you find ¹.

Angle closure refers to the appositional or synechial closure of the anterior chamber angle where the peripheral iris is pressed against the trabecular meshwork, resulting in aqueous outflow obstruction. Gonioscopy remains the reference standard technique for identifying iridotrabecular contact (ITC).

Primary angle closure glaucoma (PACG) is characterized by the presence of glaucomatous optic neuropathy with compatible visual field loss, in association with occludable drainage angles (defined as an angle in which ≥180° of the posterior trabecular meshwork is not visualized on gonioscopy in the primary position of gaze). PACG is frequently associated with either elevated intraocular pressure (IOP) and/or peripheral anterior synechiae (PAS).