Acute Angle-Closure Glaucoma In An Elderly Woman With Elevated Intraocular Pressure: A Case Report

Abstract

Acute angle-closure glaucoma is an ophthalmic emergency that can lead to irreversible vision loss if elevated intraocular pressure is not promptly managed. Typical clinical manifestations include acute ocular pain, decreased visual acuity, ocular redness, corneal edema, a mid-dilated pupil, and elevated intraocular pressure. This case report aims to describe the clinical manifestations, diagnostic process, and management principles of acute angle-closure glaucoma in an elderly patient. A 65-year-old woman presented with a chief complaint of sudden decreased vision in the left eye that had begun two weeks prior to examination. The complaint was preceded by intermittent tearing and a dull aching sensation in the left eye for approximately one month. Two weeks before presentation, the patient experienced severe pain in the left eye radiating to the left side of the head, accompanied by ocular redness, eyelid swelling, and markedly blurred vision described as seeing through smoke. The right eye had experienced a gradual decline in vision over approximately one year. Examination revealed uncorrected visual acuity of 20/60 in the right eye and 1/60 in the left eye. The left eye showed eyelid edema, lacrimation, ciliary and conjunctival injection, corneal edema and opacity, a shallow anterior chamber, iris bombe, a mid-dilated pupil, and an absent pupillary light reflex. Intraocular pressure was 18 mmHg in the right eye and 49 mmHg in the left eye. Confrontation visual field testing revealed generalized constriction of the visual field in the left eye. Based on the clinical findings, the patient was diagnosed with acute angle-closure glaucoma in the left eye and immature senile cataract in the right eye. The patient received intraocular pressure-lowering medical therapy and was scheduled for further evaluation and definitive treatment with laser peripheral iridotomy once the corneal condition permitted the procedure. Acute angle-closure glaucoma should be considered in elderly patients presenting with a red eye, acute ocular pain, decreased vision, and elevated intraocular pressure. Prompt recognition of clinical signs and immediate reduction of intraocular pressure are essential to minimize the risk of irreversible optic nerve damage. Evaluation of the fellow eye is also important because of the presence of anatomical predispositions that may increase the risk of a similar attack.