An ophthalmic emergency with severe shooting pain, blurred vision, and
mid-dilated pupils in a 52-year-old woman.

The emergency department received a 52-year-old woman with complaints of severe retrobulbar pain and blurred vision in her left eye for the past 24 hours. On inquiring, she described her pain as constant and shooting in character, each time lasting for a couple of seconds only.

On examination of her left eye, the conjunctiva was red with mid dilated pupils. The left eye was unresponsive to light. On palpation, the hardening of the left orbit was appreciated.

The visual acuity was 20/125 in the left eye. العاب لربح المال على النت

The intraocular pressure of the left eye was 55 mm Hg (normal range, 10 to 21).

A diagnosis of acute angle-closure glaucoma was made.

Intravenous acetazolamide and an αlpha2-adrenergic agonist were given to the patient. Acetazolamide is a topical carbonic anhydrase inhibitor given to reduce the intraocular pressure, subside the inflammation, and reverse the angle closure. The patient then underwent laser iridotomy resulting in rapid relief of her symptoms.

After the procedure, the patient was kept under observation and was discharged 4 hours later. At the time of discharge, her intraocular pressure was 10 mm Hg. العاب القمار اون لاين Thereafter, the patient did not follow-up.

Acute angle-closure glaucoma

Acute angle-closure glaucoma is an ophthalmologic emergency warranting immediate medical attention. It is due to the blockage of the drainage canal; quite similar to a clogged drain of the sink.

Due to the obstruction of the canal, the intraocular pressure
rapidly increases as the flow of aqueous humor is impaired.

Patients usually present with severe pain in the eye with
impaired/blurred vision, halos around light, headache, nausea, and vomiting.

The symptoms of acute angle-closure glaucoma are precipitated by pupillary dilation, which may happen when in the dark environment. Usually, patients complain after being in a movie theatre or where the lights are dim. Some may give a history of taking medications, including over-the-counter drugs for cold or allergy, like antihistamines, or drops used for pupillary dilation for an ophthalmic examination.

The primary goal of management in an emergency is to lower the intraocular pressure. To lower the pressure, the patient should first be positioned such that the patient is lying on his or her back. This shifts the lens posteriorly, helping in relieving the block. Acetazolamide should be given as immediately as possible and also the topical drops for glaucoma, including alpha agonists, beta-blockers, or prostaglandin analogs. Symptomatic management with anti-emetics and analgesics may also be necessary.

Surgical procedures for angle-closure glaucoma are generally
quite successful and long-lasting

References

Heiko Pohl, M. a. (2018, March 08). Acute Angle-Closure Glaucoma. لعبة بلاك جاك Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1712742

Murray D. Emergency management: angle-closure glaucoma. Community Eye Health. 2018;31(103):64.