Prevalence of Nausea and Vomiting in Acute Angle-Closure Crisis
Nausea and vomiting are recognized systemic manifestations of acute angle-closure crisis (AACC), though specific prevalence rates are not quantified in current clinical guidelines. 1, 2
Clinical Context
The American Academy of Ophthalmology identifies nausea and vomiting as characteristic clinical signs and symptoms of AACC, occurring alongside other features such as: 1
- Pressure-induced corneal edema (causing blurred vision and multicolored halos around lights) 1, 2
- Mid-dilated, poorly reactive or fixed pupil 1, 2
- Severe eye pain and headache 1, 2
- Conjunctival and episcleral vascular congestion (red eye) 1, 2
- Markedly elevated intraocular pressure (typically >40 mmHg) 2
Mechanism of Gastrointestinal Symptoms
These gastrointestinal symptoms result from the acute spike in intraocular pressure, often accompanied by severe headache. 2 The systemic nature of these symptoms can lead to diagnostic confusion, as patients may initially present to emergency departments with nausea and vomiting as their chief complaint rather than ocular symptoms. 3
Clinical Significance
Diagnostic Considerations
While nausea and vomiting are well-established features of AACC, they are not universal findings. 1 The presence of these symptoms should prompt immediate consideration of AACC when accompanied by: 1, 2
- Sudden onset severe eye pain
- Blurred vision or halos around lights
- Red eye with mid-dilated pupil
- History of hyperopia or narrow angles
Important Pitfalls
Do not dismiss eye pain accompanied by nausea and vomiting as a primary gastrointestinal or neurological condition without measuring intraocular pressure and assessing the pupil. 2 The American Academy of Ophthalmology emphasizes that untreated AACC can cause blindness within hours, making rapid diagnosis critical. 2
Transient episodes of nausea with eye discomfort should not be dismissed as benign, as these represent warning signs of intermittent angle closure before potentially blinding acute attacks. 4 Patients with intermittent angle closure may experience episodic symptoms including nausea that resolve spontaneously when the pupillary block breaks. 4
Limitations of Current Evidence
The major ophthalmology guidelines from the American Academy of Ophthalmology (2016,2021) list nausea and vomiting as clinical features of AACC but do not provide specific prevalence data or percentages of affected patients. 1 This reflects the clinical reality that these symptoms occur variably and are not required for diagnosis, which relies primarily on elevated IOP, gonioscopic findings, and characteristic ocular signs. 1