Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Glaucoma, Acute (Angle-Closure)


Related Terms

  • Argon Laser Peripheral Iridoplasty
  • Iridectomy
  • Laser Gonioplasty
  • Laser Iridotomy
  • Laser Peripheral Iridotomy
  • Open Angle
  • Vision Loss

Differential Diagnosis

Specialists

  • Ophthalmologist

Comorbid Conditions

Factors Influencing Duration

Length of disability depends on the extent of damage caused by the condition, the severity of the attack, promptness of treatment, and the individual's response to treatment.

Medical Codes

ICD-9-CM:
365.22 - Glaucoma, Acute Angle-closure

Overview

Glaucoma is a disease that damages the retinal nerve fibers and the optic nerve as a result of elevated pressure within the eye (intraocular pressure). Acute (angle-closure) glaucoma (AACG) occurs suddenly in individuals with an abnormal eye structure that traps fluid (aqueous humor) behind the colored portion of the eye (iris), preventing proper drainage. When this fluid is unable to circulate properly and cannot exit the eye through natural channels, pressure in the eye increases. With AACG, intraocular pressure may increase rapidly, and immediate treatment is necessary to preserve vision and prevent optic nerve damage.

While other types of glaucoma may exist for years without detection, the acute form of the disease can manifest as an emergency due to sudden onset. Untreated AACG and increasing intraocular pressure can lead to a bulging iris (iris bombe). When intraocular pressure becomes too high permanent vision loss, including blindness, can result.

AACG is characterized by at least 3 of the following signs: intraocular pressure exceeding 21 millimeters of mercury (mm Hg); swelling of the corneal epithelium; a nonreactive pupil that is partially dilated; a shallow, occluded ocular chamber; and bloodshot eyes (conjunctival injection) (Darkeh). In addition, two of the following symptoms will be present: eye pain, intermittently blurry vision, and nausea with vomiting (Darkeh).

Incidence and Prevalence: Prevalence of AACG is 100 to 4,000 cases per 100,000 population but varies by ethnicity (Darkeh). Among whites, the prevalence of AACG is approximately 1 in 1,000 population, among Asians, 1 in 100 population, and among Eskimos, 2 to 4 in 100 population (Darkeh). Incidence of AACG is low in Native Americans (Noecker & Kahook). Overall incidence of AACG in whites is 3.8%(Rhee & Gedde). AACG accounts for 10% of all cases of glaucoma that occur in the US (Rhee).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who are farsighted (hyperopic) are at increased risk for AACG (Noecker and Kahook). Risk of AACG is highest in Asians and Eskimos, who have a naturally narrower angle. Incidence of AACG is low in Native Americans (Noecker & Kahook). AACG is about 3 times more common in women than in men (Noecker & Graham).

AACG is most common in individuals age 50 to 70 years, since the aging process may cause the lens of the eye to thicken and block the normal outflow of aqueous humor (Darkeh). AACG may be triggered by taking certain medications (e.g., antidepressants, anticholinergics, antihistamines, antipsychotics, antispasmodics, and sympathomimetics); an episode of rapidly corrected hyperglycemia; or experiencing pupillary dilation, such as occurs when working in dim light or undergoing an eye exam (Darkeh; Noecker & Kahook; Rhee & Gedde).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may complain of headache, blurred vision with halos around lights, and a red painful eye. Pain may be severe and accompanied by nausea and vomiting. Profuse tearing may also be reported.

Physical exam: A red eye with a fixed, partially dilated pupil may be detected during physical examination. The clear, front part of the eye (cornea) may appear hazy.

Tests: Intraocular pressure measurement (tonometry) may be quite high, often more than 40 to 80 mm Hg (Noecker & Kahook; Rhee). Examination of the interior eye structure using a specialized contact lens (gonioscopy) helps identify possible structural defects creating blockages of fluid and allows visualization of the drainage angle of the eye. A test using a slit lamp microscope (biomicroscopy) is performed to view the front chamber of the eye and may reveal a shallow anterior chamber, corneal swelling and redness, or inflammation. Visual field and visual acuity testing also are performed.

Source: Medical Disability Advisor



Treatment

In an acute attack, individuals must lie on the back (supine) as much as possible with the eyes open to reduce intraocular pressure and pupillary dilation. Ocular medication, such as beta-blockers (e.g., timolol), miotic agents (e.g., pilocarpine), and alpha-agonists (e.g., apraclonidine), as well as oral and/or intravenous medication, such as carbonic anhydrase inhibitors (e.g., acetazolamide, methazolamide), and osmotic agents (e.g., glycerol, mannitol), may be used to lower intraocular pressure. Topical steroids are given to reduce inflammation and prevent damage to the optic nerve. Medications to reduce pain and to decrease nausea and vomiting (anti-emetics) are necessary to prevent a further rise in intraocular pressure.

When inflammation has subsided and the eye has stabilized (typically within 24 to 48 hours), laser incision of the iris (laser peripheral iridotomy) is used either to make a hole in the iris to improve fluid drainage or removal of part of the iris (iridectomy) (Darkeh). This usually opens drainage systems and prevents any further attacks. Argon laser peripheral iridoplasty (laser gonioplasty), a treatment in which small laser burns are made in the eye to contract the iris and open the angle, may also be performed as a temporary measure. After surgery, intraocular pressure is checked at 1 hour post-operatively, and again 1 day later to determine if additional intervention is necessary (Noecker & Graham). AACG often develops later in the unaffected eye, which also may be treated as a precautionary measure.

Source: Medical Disability Advisor



Prognosis

With timely treatment, most individuals regain their vision. In whites, laser peripheral iridotomy generally is effective in controlling intraocular pressure, but up to one-third of individuals will need to continue using topical medication to control intraocular pressure (Darkeh). Individuals of Asian descent most frequently experience repeat attacks of AACG, and a greater percentage need to use medications to control intraocular pressure after the initial attack (Darkeh).

Untreated acute glaucoma may result in severe and permanent vision loss within days of onset of symptoms. Timely treatment is crucial for a good outcome. If the condition persists or recurs after laser iridotomy, an iridectomy may be performed to secure a more permanent solution.

Source: Medical Disability Advisor



Complications

Complications associated with the disease include blindness, dislocation of the eye's lens, and emotional stress. Trapped fluid (ciliary block), infection, bleeding, and cataracts occur as a complication of eye surgery. Because there is an 80% chance of the other eye developing AACG, laser peripheral iridotomy frequently is performed on the non-affected eye as a precaution (Rhee).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Permanent vision impairment may prevent or hinder performance of previous duties. When vision loss has occurred, larger computer screens or magnifying lenses may be helpful; however, permanent reassignment to duties requiring less visual acuity may be necessary.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Have red eye conditions with similar symptoms, such as uveitis, conjunctivitis, or corneal disorders, been ruled out?
  • Did individual have signs such as intraocular pressure greater than 21 mm Hg, swelling of the corneal epithelium, a nonreactive pupil that is partially dilated, and a shallow, occluded ocular chamber?
  • Did individual have symptoms that include eye pain, intermittently blurry vision, and nausea with vomiting?
  • Were individual's eye been tested thoroughly for presence of structural defects that could be causing the condition?
  • Does individual have an underlying condition, such as anterior uveitis, dislocation of the eye's lens, emotional stress, diabetes, cataracts, or use of certain antihistamines, antidepressants, or other drugs that may contribute to the condition or affect recovery?
  • Are underlying conditions receiving appropriate treatment?
  • Has individual had recent eye exam in which the pupils were dilated?

Regarding treatment:

  • Has individual received ocular medication, such as beta-blockers, miotic agents, and alpha-agonists, as well as oral and/or intravenous medication, such as carbonic anhydrase inhibitors and osmotic agents, to lower eye pressure?
  • Have topical steroids been given to reduce eye inflammation?
  • Has individual received analgesics and anti-emetic medications to reduce pain and to decrease nausea and vomiting?
  • Has individual received laser surgery or other appropriate treatment to encourage proper drainage of fluids that might be trapped within the eye?
  • Was intraocular pressure checked again 1 hour after surgery to ensure a drop in intraocular pressure? 1 day after surgery?
  • Has the other eye been treated as a precautionary measure?
  • Has individual been taking medication that may contribute to onset of the disease?
  • Is age a factor in the severity of the condition?

Regarding prognosis:

  • Was treatment given promptly after onset of the disease?
  • Will individual need to continue taking topical medication to control intraocular pressure?
  • Have underlying conditions that may contribute to this disease been identified and properly addressed?
  • Are underlying conditions responding to treatment?
  • Can employer make appropriate accommodations for the individual with vision loss?

Source: Medical Disability Advisor



References

Cited

Darkeh, Ayim K., and Mark A. Silverberg. "Glaucoma, Acute Angle-Closure." eMedicine. Eds. Michelle Ervin, et al. 12 Aug. 2009. Medscape. 30 Oct. 2009 <http://emedicine.medscape.com/article/798811-overview>.

Noecker, Robert J., and Lauri Graham. "Acute Angle-Closure Glaucoma." eMedicine Health. Eds. Richard W. Alliinson, et al. 18 Nov. 2005. WebMD, LLC. 30 Oct. 2009 <http://www.emedicinehealth.com/acute_angle-closure_glaucoma/article_em.htm>.

Noecker, Robert J., and Malik Y. Kahook. "Glaucoma, Angle Closure, Acute." eMedicine. Eds. Kilbourn Gordon, et al. 18 Jun. 2009. Medscape. 20 Oct. 2009 <http://emedicine.medscape.com/article/1206956-overview>.

Rhee, Douglas J. "Angle Closure Glaucoma." The Merck Manual for Healthcare Professionals. Aug. 2008. Merck & Co., Inc. 1 Nov. 2009 <http://www.merck.com/mmpe/sec09/ch103/ch103c.html>.

Rhee, Douglas J., and Steven Gedde. "Glaucoma, Drug-Induced." eMedicine. Eds. Andrew I. Rabinowitz, et al. 18 May. 2009. Medscape. 30 Oct. 2009 <http://emedicine.medscape.com/article/1205298-overview>.

Source: Medical Disability Advisor






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