Misdiagnosis of angle closure glaucoma

Gordon-Bennett, Patel; Ung, Tsiang; Stephenson, C. B. S.; Hingorani, Melanie

doi:10.1136/bmj.39024.570313.ae

Cited by 15 publications

(6 citation statements)

References 5 publications

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“…103 The two injuries most commonly described are ischaemic optic neuropathy 73 86 and central retinal artery occlusion. 63 66 Other complications which have been observed in the prone, anaesthetized patient include supraorbital neuropraxia, occurring in three patients associated with other injury, 75 222 transient and permanent ophthalmoplegia in nine patients 66 75 96 218 222 and single case reports of cavernous sinus thrombosis, 11 central retinal vein occlusion, 181 unexpected presentation of an orbital haemangioma, 60 painful orbital compartment syndrome, 106 bilateral angle closure glaucoma, 58 non-traumatic subperiosteal orbital haemorrhage, 225 amaurosis, 88 dislocated intraocular lens 93 and fixed mydriasis. 23 Studies have been conducted examining keratoconjunctival injury 19 and postoperative chemosis 81 both of which have been observed after prone positioning.…”

Section: Indirect Pressure Injuriesmentioning

confidence: 99%

Anaesthesia in the prone position

Edgcombe

Carter

Yarrow

2008

British Journal of Anaesthesia

438

288

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Prone positioning of patients during anaesthesia is required to provide operative access for a wide variety of surgical procedures. It is associated with predictable changes in physiology but also with a number of complications, and safe use of the prone position requires an understanding of both issues. We have reviewed the development of the prone position and its variants and the physiological changes which occur on prone positioning. The complications associated with this position and the published techniques for various practical procedures in this position will be discussed. The aim of this review is to identify the risks associated with prone positioning and how these risks may be anticipated and minimized.

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Section: Indirect Pressure Injuriesmentioning

confidence: 99%

Anaesthesia in the prone position

Edgcombe

Carter

Yarrow

2008

British Journal of Anaesthesia

438

288

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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].…”

mentioning

confidence: 79%

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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“…It is thus sometimes misdiagnosed as migraine. 25 The pupil may be fixed or irregular with conjunctival injection. 25 If suspected, intraocular pressure measurement is diagnostic.…”

Section: Other Serious Secondary Headachesmentioning

confidence: 99%

Assessment of acute headache in adults – what the general physician needs to know

et al. 2018

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Headache is common. Up to 5% of attendances to emergency departments and acute medical units are due to headache. Headache is classifi ed as either primary (eg migraine, cluster headache) or secondary to another cause (eg meningitis, subarachnoid haemorrhage). Even in the acute setting the majority of cases are due to primary causes. The role of the attending physician is to take a comprehensive history to diagnose and treat benign headache syndromes while ruling out sinister aetiologies. This brief article summarises the approach to assessment of headache presenting in acute and emergency care.

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Misdiagnosis of angle closure glaucoma

Cited by 15 publications

References 5 publications

Anaesthesia in the prone position

Anaesthesia in the prone position

Acute Angle Closure Glaucoma Presented with Nausea and Epigastric Pain

Assessment of acute headache in adults – what the general physician needs to know

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