An Eye Emergency: Acute Closed Angle Glaucoma

Glaucoma in most patients takes years to cause visual damage. But there’s one type of glaucoma that is a true medical emergency: acute closed angle (or angle closure) glaucoma. The fluid outflow from the eye becomes suddenly blocked completely, pressure inside the eye soars, and vision can be permanently damaged unless treatment occurs within hours.

The “classic” signs of acute angle closure glaucoma are: sudden onset of severe pain in the eye, nausea/vomiting, and blurred vision. But this of course is the “no brainer” presentation that few doctors will miss. British researchers found that many cases of acute glaucoma lack this obvious cluster of signs. Instead, there might only be red eye and blurred vision, without any pain. In an article by D. Siriwardena and others, “Misdiagnosis of Acute Angle Closure Glaucoma,” they found that six in ten cases of acute glaucoma were missed, causing a delay in treatment of up to one week. The researchers concluded:

Because acute glaucoma can present without its typical features, there needs to be a high index of suspicion for this diagnosis. This diagnosis does not require expensive equipment or a high level of training—all our patients had a significant reduction in vision.

Any patient who has a red eye and a subjective or objective reduction in vision should be referred to an ophthalmologist the same day.

Next: Other risky situations for glaucoma misdiagnosis and malpractice

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