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Primary acute closed-angle glaucoma is caused by the inhibition of the circulation of aqueous humour. From the ciliary body, aqueous humour crosses the posterior chamber, through the pupil into the anterior chamber. The majority of fluid drains through the trabecular meshwork and Schlemm canal into the circulation through the angle of the eye.
Around 10 per cent drains out via the uveo-scleral venous outflow. In closed-angle glaucoma this trabecular pathway is disrupted. The anatomy of the eye prevents the aqueous humour from passing through the pupil, inducing pupil block, which in turn leads to crowding of the anterior chamber angle, preventing any fluid from draining through the trabeculae. Raised intraocular pressure (IOP) affects the optic nerve. Recent research has shown how very high IOP leads to optic disc changes in an hour.1
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