Recent developments and clinical studies indicate that primary phacoemulsification and intraocular lens implantation are safe and effective for the surgical treatment of primary angle closure glaucoma (ACG) compared to conventional iridectomy or laser-iridotomy. When compared to control eyes treated using standard peripheral iridectomy, the outcome in terms of intraocular pressure control, adjunct anti-glaucoma medication, visual acuity, and the necessity for successive surgical interventions favored primary phacoemulsification and intraocular lens implantation. Earlier biometric data underline the importance of the "lens factor" in the pathogenesis of relative pupillary block in ACG obtained by Scheimflug image processing and ultrasound biomicroscopy. The vast improvements in modern cataract surgery combined with our current understanding of the pathogenesis of relative pupillary block in ACG indicate that lens extraction is a better procedure in uncontrolled angle closure glaucoma than conventional iridectomy.