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Attack of acute angle-closure glaucoma ?
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Attack of acute angle-closure glaucoma ?

Female, 64. Farsighted with some astigmatism. Was diagnosed with narrow angle a couple of years ago. IOP before dilation was normal.Had an appointment yesterday with retina specialist. Was dilated with mydriacyl 2.5% and phenylethrine. Everything was fine, was told to schedule in a year. When I got out after the appointment, I had to wait more than an hour because unusual for me tearing and light sensitivity.8 hours later my right eye started hurting, also right side of the head. Pain comes and go, level 3 (on a scale 0-10 ),slightly radiated down to front sinus, right side of the nose. No redness, no discharge, no pain on touch, but the eye feels heavy. 24 hours later: the eye still hurts, maybe little less. No changes in vision, no halos around lights.
Will be very thankful for professional comment.
Annush.
8 Comments Post a Comment
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Your eye pressure after dilation?
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You need to be seen by an ophthalmologist and evaluated for angle closure glaucoma. NOTE: you angle needs to be very carefully checked, undilated with an instrument called a gonioscope.  If your angles are narrow enough to be occludeable you need laser peripheral iridectomies.  If are narrow but not occludable need to have that watched closely as we age the angle narrows due to lens getting larger in diameter.  You can have an attack of angle closure without severe pain, without halos.

JCH MD

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Dear Dr. Hagan,
If a patient with narrow angle glaucoma did have measured the iop's before and after dilation, would that be a profound indication of this problem?
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Even in patients with normal open angles the IOP often goes up some after dilation.  Even in patients with very narrow angles that have their eyes dilated the IOP may not be abnormally elevated at maximal dilation. The angle closure often occurs as the pupil is coming down to normal size as this is the time of maximum "pupillary block".

JCH MD
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Thank you.
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You're welcome  JCH MD
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PS.
So the "narrow angle glacoma patient" should or should not request a pressure check before and after dilation?
Bearing your comments in mind.
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The narrow angle patient needs to know if the angles are or are not occudible.  If we think the former by gonioscopy we do laser peripheral iridectomy; if not we advise the patient to report severe pain, halos, fixed pupil, etc but we don't measure the pressure at end of exam

JCH MD
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