Symptoms of Acute Glaucoma
The classic symptoms of acute angle-closure glaucoma include severe eye pain, blurred vision, halos around lights, headache, nausea/vomiting, eye redness, and mid-dilated pupil. 1
Key Clinical Manifestations
Ocular Symptoms
- Eye pain: Severe, often described as a deep aching sensation
- Visual disturbances:
- Blurred vision
- Halos around lights (particularly colored halos)
- Decreased visual acuity
- Occasionally complete vision loss if untreated
- Eye redness: Conjunctival hyperemia and episcleral vascular congestion
- Mid-dilated pupil: Often oval or irregular in shape
- Poor pupillary reactivity: Sluggish or absent response to light
Systemic Symptoms
- Headache: Often severe, may be mistaken for migraine or cluster headache
- Nausea and vomiting: Common accompanying symptoms due to severe pain and elevated intraocular pressure
- General malaise: Patient appears distressed
Physical Examination Findings
- Corneal edema: Appears cloudy with microcystic and stromal edema
- Shallow anterior chamber: Both centrally and peripherally
- Elevated intraocular pressure: Often extremely high (>40-50 mmHg)
- Anterior chamber inflammation: May be present during or after an attack
- Lens changes: May show glaukomflecken (patchy, localized anterior subcapsular lens opacities) after an attack 1
Important Considerations
Atypical Presentations
- Some cases may present without pain, mimicking transient ischemic attacks or amaurosis fugax 2
- Symptoms may not always be clearly referable to the eyes, leading to misdiagnosis 3
- May be mistaken for other conditions like cluster headache or migraine 4, 5
Risk Factors
- Anatomical factors:
- Hyperopia
- Shallow anterior chamber depth
- Short axial length
- Thick crystalline lens
- Steep corneal curvature 1
- Demographic factors:
- Higher prevalence in Asian populations, particularly Chinese
- More common in older adults (>50 years)
- Family history increases risk 1
Medication-Induced Acute Angle Closure
Certain medications can trigger acute angle closure in susceptible individuals:
- Anticholinergics (including some inhalers)
- Adrenergic agents
- Sulfonamides (including topiramate)
- Phenothiazines 1, 6
Clinical Significance
Acute angle-closure glaucoma is an ophthalmological emergency requiring immediate treatment. Without prompt intervention:
- Retinal nerve fiber layer damage occurs rapidly
- Permanent vision loss can develop
- 18% of eyes may become blind following an acute attack
- Nearly half develop glaucomatous optic neuropathy 1
Action Steps
If acute angle-closure glaucoma is suspected:
- Refer immediately to ophthalmology for same-day evaluation
- Do not dilate the affected eye
- Palpation of the globe can help non-ophthalmologists detect markedly elevated intraocular pressure 3
- Evaluate the fellow eye, as it is also at high risk for developing acute angle closure 1
Remember that prompt diagnosis and treatment are essential to prevent permanent vision loss in this true ophthalmological emergency.