Diabetes with Eye Pain and Headache - Patient Case of the Week
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Try this case and test your knowledge of eye pain.
Which of the following signs will be associated with the patient's diagnosis?
deep anterior chamber
Describe the physical findings associated with acute angle-closure glaucoma.
Eye redness, while nonspecific, is found almost universally in patients with acute angle-closure glaucoma.
This patient is exhibiting the signs and symptomatology of acute angle-closure glaucoma, a pathologic closing or narrowing of the anterior chamber of the eye. If it is left uncorrected then intraocular pressure builds up, thereby causing insult to the optic nerve and subsequent blindness. It is considered an ophthalmologic emergency in which immediate consultation with an ophthalmologist is essential.
Angle-closure glaucoma can be either primary or secondary. In cases of primary angle-closure glaucoma, patients have ocular anatomic features that predispose them to the condition. In secondary angle-closure glaucoma, something causes the condition. Examples of secondary angle-closure include trauma-induced hemorrhage into the eyeball, diabetic retinopathy, ocular ischemia, mass effect from tumors, or inflammatory conditions. In acute angle-closure glaucoma, the conjunctiva is almost universally red due to dilatation of conjunctival vessels. This is particularly pronounced near the cornea from ciliary flush.
The figure below shows the typical cloudy cornea, as well as redness of the conjunctiva with a shallow anterior chamber and narrowing of the angle between the iris and cornea.
Other findings include a hazy cornea from edema, a shallow (not deep) anterior chamber, and a mid-dilated pupil (generally ~4-5 mm) poorly reactive to light.
Evaluation involves visual acuity assessment, measuring intraocular pressure, slit-lamp evaluation, and examination of the fundus. Gonioscopy is the gold-standard for diagnosis and involves visualizing the angle with a special slit lamp lens.
Pokhrel PK, Loftus SA. Ocular emergencies. Am Fam Physician. 2007;76:829.
Prum BE Jr, Rosenberg LF, Gedde SJ, et al. Primary open-angle glaucoma preferred practice pattern guidelines. Ophthalmology. 2016;123:P41.
See JLS, Chew PTK. Angle-closure glaucoma. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed., 2009:1162.