An uncommon presentation of acute angle closure glaucoma

Berkoff, David J.; Sánchez, León D.

doi:10.1016/j.jemermed.2005.01.011

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…In our case, unfortunately, the initial findings were attributed to conjunctivitis. In addition, as was seen in our patient, there are systemic symptoms as well (intense headache, nausea, vomiting, abdominal pain), which may be so severe that patients are misdiagnosed as having a neurologic or gastrointestinal disease [2][3][4].…”

supporting

confidence: 65%

“…The high intraocular pressure can damage the optic nerve and lead to blindness. It is more common in elderly people and women, and is considered an emergency because vision loss can occur within hours of the onset of the symptoms [2]. Prompt diagnosis needs high index of suspicion, and it is based on topical symptoms (ocular pain, redness, blurred vision with coloured halos) and clinical examination (dilated and fixed pupil) [1].…”

mentioning

confidence: 99%

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Acute Angle Closure Glaucoma Presented with Nausea and Epigastric Pain

Pipili¹,

Dasenaki²

2007

Dig Dis Sci

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A 78-year-old woman was admitted to our department with nausea, vomiting, epigastric pain, and intense headache of the left side of 1 day duration. She had suffered from diabetes mellitus for the last 7 years and was being treated with a combination of metoformin (850 mg twice daily) and glimepiride (1 mg/day). In addition, for the last 5 years she was being treated for atrial fibrillation with acenocoumarol 1 mg/day. The patient also suffered from lumbar pain due to osteoarthritis and was being treated with a combination of paracetamol plus orphenadrine citrate (Norgesic) (450 + 35 mg per day) for the last 10 days.On admission, the patient was afebrile and the clinical examination revealed obesity, high arterial blood pressure (170/95 mmHg), and epigastric pain without clinical signs of peritonitis. Her left eye was red, and the pupil was more dilated and less reactive to light compared to the right eye. Laboratory findings included a hematocrit measurement of 44.5%, WBC at 8,900/mm 3 , C-reactive protein of 4 mg/l, and total bilirubin at 1.3 mg/dl (direct 0.5 mg/dl). An ultrasound of the upper abdomen was without abnormal findings. A CT scan of the head was normal. Antiemetics and proton pump inhibitors were initiated, and with the diagnosis of possible conjunctivitis, a tobramycin eye ointment was given. The next day, the patient's nausea had improved, but her headache had worsened and she reported a blurred vision from her left eye and photophobia. After reevaluation of her history and clinical findings, a digital tonometer was used which revealed an opening pressure of 62 mmHg on the left and 32 mmHg on the right eye. The diagnosis of acute angle closure glaucoma (AACG) was made, treatment was immediately started (eye drops of pilocarpine 2% and timolol 0.5%, acetazolamide 250 mg per os, and mannitol 1.0 mg/kg IV), and the patient was transferred to the ophthalmology department for further evaluation and management.

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confidence: 65%

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confidence: 99%