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Education And Debate

Lesson of the Week: Acute angle closure glaucoma masquerading as systemic illness

BMJ 1996; 313 doi: (Published 17 August 1996) Cite this as: BMJ 1996;313:413
  1. Margaret Dayan, registrar in ophthalmologya,
  2. Benjamin Turner, senior house officer in ophthalmologya,
  3. Charles McGhee, consultant ophthalmologistb
  1. aSunderland Eye Infirmary, Sunderland SR2 9HP
  2. bUniversity of Sunderland School of Health Sciences, Sunderland SR2 7EE
  1. Correspondence to: Miss M Dayan, Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP.
  • Accepted 24 May 1996

Acute angle closure glaucoma is a comparatively rare, acute form of glaucoma that may be associated with various systemic symptoms; these can overshadow the primary ocular problem. In some cases this delay in diagnosis may result in blindness. We report on three women who presented to our department with acute angle closure glaucoma during one fortnight. Their initial symptoms were attributed to surgical and psychiatric problems rather than to their ocular disease.

Acute angle closure glaucoma can present with systemic symptoms such as headache or gastrointestinal disturbance

Case reports CASE 1

A 63 year old hypermetropic (long sighted) woman presented to her general practitioner with a 24 hour history of right sided headache followed, several hours later, by vomiting, diarrhoea, and non-specific abdominal pain. Her symptoms failed to settle and she was referred to hospital and admitted under a surgical team. No cause could be found for her gastrointestinal disturbance, but the following day her right eye was noted to be red; on direct questioning she admitted to a reduction in visual acuity in that eye, which had coincided with the onset of her symptoms. She was referred to the eye accident and emergency department.

The visual acuity in her right eye was reduced to hand movements and associated with a raised intraocular pressure of 44 mm Hg (normal range 10-21 mm Hg), a fixed, mid-dilated pupil, substantial corneal oedema, and a very shallow anterior chamber. Angle closure glaucoma was diagnosed and the intraocular pressure lowered medically. Her systemic symptoms resolved completely. Bilateral laser peripheral iridotomies were performed on the next day. Her visual acuity improved to 6/12 in the right eye compared with 6/6 in …

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