Primary Angle-Closure Glaucoma
Primary angle-closure glaucoma (PACG) refers to acute or chronic elevation of intraocular pressure caused by primary angle closure, with or without glaucomatous optic disc changes and visual field loss. Based on clinical presentation, PACG is classified as acute angle-closure glaucoma or chronic angle-closure glaucoma. Its main clinical features include ocular distension and pain, headache, reduced vision, elevated intraocular pressure, and possible visual field loss. According to the traditional classification, primary acute angle-closure glaucoma is divided into the preclinical, prodromal, acute, remission, and chronic stages. Primary chronic angle-closure glaucoma is divided into early, progressive, and late stages. An affected eye with complete blindness and uncontrollable intraocular pressure is considered to be in the absolute stage. In traditional Chinese medicine (TCM), this condition falls within the categories of “Qingfeng Neizhang,” “Lufeng Neizhang,” and “Huangfeng Neizhang.”
TCM Pattern Differentiation and Medication Reference
|Common Symptoms
Clinical Description:
Sudden onset, with severe, splitting headache and intense distending eye pain as if the eye might protrude, radiating to the orbit; vision drops abruptly and may even be lost; circumcorneal redness, diffuse conjunctival redness and edema, hazy corneal opacity, a dilated pupil with a pale green hue, and a hard eyeball. Systemic symptoms may include nausea and vomiting, chills and fever, dark urine, and constipation. The tongue is red with a yellow coating, and the pulse is wiry and rapid.
In Plain Language:
- Symptoms begin very suddenly, with an extremely severe headache that feels as if the head is splitting.
- The eye feels distended and painful, as if it might protrude; the pain may extend to the orbit.
- Vision suddenly becomes markedly impaired and, in severe cases, may be lost.
- There is a ring of redness around the cornea.
- The white of the eye is red and cloudy, with swelling.
- The cornea looks hazy and cloudy rather than clear.
- The pupil is dilated and appears pale green.
- The eyeball feels hard to the touch, and pressure may increase discomfort.
- Nausea and vomiting, chills, and fever may occur.
- Urine may be dark yellow or reddish, and stools may be hard and difficult to pass.
- The tongue appears red with a yellow coating.
- The pulse is described as wiry and relatively rapid.
|Treatment Approach
Clinical Description:
Clear heat and drain fire; cool the Liver and extinguish wind.
In Plain Language:
- In TCM terms, this approach aims to clear internal heat and fire, which are associated with symptoms such as fever, sore throat, thirst, irritability, and facial flushing.
- It aims to reduce Liver fire and calm internal wind, traditionally associated with red eyes, head distension, dizziness, spasms, and trembling in the hands and feet.
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
|Common Symptoms
Clinical Description:
Sudden onset, with eye symptoms similar to those associated with exuberant Liver-Gallbladder fire; often accompanied by fever and facial flushing, dizziness with movement, nausea and vomiting, dark urine, and constipation. The tongue is red with a yellow, greasy coating, and the pulse is wiry, slippery, and rapid.
In Plain Language:
- Symptoms begin very suddenly and develop rapidly.
- Eye symptoms resemble those described as “exuberant Liver-Gallbladder fire,” such as red, swollen, hot, painful eyes, light sensitivity, tearing, and blurred vision.
- There may be fever and facial flushing.
- Dizziness may occur easily.
- Nausea, retching, or vomiting may occur.
- Urine may appear dark yellow or reddish.
- Stools may be hard and difficult to pass.
- The tongue appears red.
- The tongue coating is yellow and greasy.
- The pulse is described as wiry, slippery, and relatively rapid.
|Treatment Approach
Clinical Description:
Reduce fire and dispel phlegm; pacify the Liver and extinguish wind.
In Plain Language:
- In TCM terms, this approach aims to clear internal fire, associated with symptoms such as dry mouth, sore throat, irritability, and facial heat.
- It aims to transform phlegm, traditionally associated with symptoms such as difficulty expectorating phlegm, coughing, and chest tightness.
- It aims to settle Liver yang and internal wind, traditionally associated with dizziness, spasms, and trembling in the hands and feet.
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
|Common Symptoms
Clinical Description:
Headache on the affected side, red and distending eye pain, dilated pupil, reduced vision, and a distended, hard eyeball; accompanied by emotional distress, chest tightness, belching, reduced appetite, nausea and vomiting, and bitter taste in the mouth. The tongue is red with a thin coating, and the pulse is wiry and rapid.
In Plain Language:
- There is a noticeable headache on the same side as the affected eye.
- The eye is red and painful, with a feeling of distension.
- The pupil is dilated.
- Vision is reduced.
- The eyeball feels distended and hard, and pressure may worsen discomfort.
- There may be low mood or emotional discomfort.
- The chest may feel tight, with frequent belching.
- Appetite may be poor, and food may seem unappealing.
- Nausea or retching may occur, and vomiting is possible.
- There may be a bitter taste in the mouth.
- The tongue appears reddish with a relatively thin coating.
- The pulse is described as wiry and rapid.
|Treatment Approach
Clinical Description:
Clear heat and soothe the Liver; direct rebellious Qi downward and harmonize the Stomach.
In Plain Language:
- In TCM terms, this approach aims to clear internal heat and soothe the Liver, traditionally associated with discomfort such as distension or pain in the chest and flanks, bitter taste, and irritability.
- It aims to direct upward-rebellious Qi downward and restore the harmonious movement of Stomach Qi, traditionally associated with nausea, vomiting, belching, acid regurgitation, abdominal bloating, and reduced appetite.
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
|Common Symptoms
Clinical Description:
Distending pain in the head and eyes, dilated pupil, blurred vision, and a hard, painful eyeball; restlessness and insomnia, dizziness and tinnitus, dry mouth and throat. The tongue is red with little coating, or dark red with scant fluids. The pulse is wiry, thin, and rapid, or thin and rapid.
In Plain Language:
- The head and eye feel distended and painful, as if pressure is pushing outward.
- The pupil is dilated.
- Vision is hazy and unclear.
- The eyeball feels hard and painful, with greater discomfort when touched or pressed.
- There may be restlessness and poor sleep or insomnia.
- Dizziness may occur along with tinnitus.
- The mouth and throat feel dry.
- The tongue may appear reddish with little coating, or dark red with signs of dryness and reduced moisture.
- The pulse may feel wiry, thin, and rapid, or thin and relatively rapid.
|Treatment Approach
Clinical Description:
Nourish yin and reduce fire; pacify the Liver and extinguish wind.
In Plain Language:
- In TCM terms, this approach aims to nourish yin and reduce internal heat, traditionally associated with dry mouth and throat, hot flashes, night sweats, and restlessness or feeling easily overheated.
- It aims to settle Liver yang and calm internal wind, traditionally associated with dizziness, spasms, trembling in the hands and feet, red eyes, and head distension.
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
References
- Jin Ming. Explanatory Notes on the TCM Clinical Diagnosis and Treatment Guidelines: Ophthalmic Diseases [M]. Beijing: China Press of Traditional Chinese Medicine, 2015: 70–78.
- Li Fengming. Chinese Ophthalmology [M]. 2nd ed. Beijing: People’s Medical Publishing House, 2005: 1129–1169.
- Glaucoma Group, Ophthalmology Branch of the Chinese Medical Association. Expert Consensus on the Diagnosis and Treatment of Primary Glaucoma in China [J]. Chinese Journal of Ophthalmology, 2014, 50(5): 382.
- Zhao Kanxing. Ophthalmology [M]. Beijing: People’s Medical Publishing House, 2010: 152–157.
- Zhang Shuxin. Glaucoma Therapy [M]. Beijing: People’s Medical Publishing House, 1998.
- American Academy of Ophthalmology. Ophthalmology Clinical Guidelines [M]. Beijing: People’s Medical Publishing House, 2006: 117–118.
- Zhou Wenbing. Clinical Glaucoma [M]. Beijing: People’s Medical Publishing House, 2000: 160–182.