Acute Angle Closure Glaucoma
Subject: A 68-year-old woman presented to the emergency department at Sacred Heart Medical Center with a one-day history of left eye pain, redness and significantly decreased vision, accompanied by severe headache, nausea and vomiting. In preceding weeks, she had experienced numerous episodes of graying out of the vision in her left eye.
Assessment/Evaluation: The patient's vision in the left eye was count fingers at 1 inch; vision in the right eye was 20/30. The left pupil was mid-dilated and fixed. Visual field by confrontation was globally depressed in the left eye. Tonometry showed pressure of 65 mmHg in the left eye (right eye, 12 mmHg). The anterior segment exam found significant severe bulbar conjunctival injection, moderate corneal edema and a moderate nuclear sclerotic cataract in the left eye. Gonioscopy revealed closed angle 360 degrees in the left eye.
Treatment: Left eye was diagnosed with acute angle closure glaucoma. The patient was brought emergently to the eye clinic, where PeaceHealth Medical Group ophthalmologist Daniel Bustos, MD, performed peripheral iridotomy, in conjunction with administration of oral and topical pressure-lowering medications.
Outcome: Following these procedures, the left eye pressure lowered to 6 mmHg with resolution of symptoms and a return to normal vision. A prophylactic laser peripheral iridotomy was performed in the right eye one week later.