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In an acute angle-closure (AAC) attack, the goal of treatment is to reduce intraocular pressure (IOP) and prevent progression to chronic angle-closure glaucoma and visual loss. Medication alone may break the AAC attack but the primary role of medical therapy is to optimize conditions so that definitive treatment (laser iridotomy) can be performed. Most classes of glaucoma medications may be utilized in the treatment of AAC glaucoma.

Pigmentary glaucoma (PG) has particular features that affect its clinical management. Outcomes tend to be similar to other types of glaucoma with similar treatments.

The refractive surgeon should be aware of the risk of pupillary block after Implantable Collamer Lens (ICL) implantation. If surgery before a neodymium:YAG (Nd:YAG) laser iridotomy is performed, the surgeon must be aware of the complete permeability of these iridotomies. The Visian Implantable Collamer Lens (ICL; STAAR Surgical) is a sulcus-placed, phakic, posterior chamber intraocular lens (PIOL) used to manage myopia, hyperopia, and myopic compound astigmatism in phakic patients [1, 2]. The ICL is designed to vault anteriorly to avoid contact with the crystalline lens. The vault is at risk of causing pupillary block; thus ICL surgery requires prophylactic placement of laser peripheral iridotomies. If the peripheral iridotomies are imperforate, pupillary-block angle closure can develop. Block can be treated with additional laser peripheral iridotomies [3, 4]. The new model of ICL surgery includes a small central hole to ensure adequate aqueous humor circulation, even in the absence of a peripheral iridotomy.