Primary angle-closure disease is a spectrum ranging from primary angle-closure suspect (PACS) to primary angle-closure glaucoma (PACG), with the prevalence of 0.1%–2.5% depending on ethnicity. Among all PACS, only 3.5%–4.4% will progress into primary angle closure (PAC). In 5 years, approximately 30% of PAC patients will progress to PACG. In newly diagnosed PACG, the key principle is to reopen all appositionally closed portions of angle, aiming to normalize intraocular pressure (IOP), and prevent further progression. Traditionally, laser peripheral iridotomy (with or without subsequent laser peripheral iridoplasty) is the mainstay in opening up the drainage angle. In this era when phacoemulsification has become a relatively safe and widely practiced procedure, lens extraction becomes one of the options as well. Although topical medications are used initially to control IOP, it is important to note that 35% of PACG eyes eventually may require surgical intervention for IOP control within the first 6 years after diagnosis. Figure 1 summarizes an approach in the surgical management of PACG.