Acute attack of primary angle closure in a highly axially myopic eye: A case report

Abstract

Objective: Background: Case Report: Conclusions: Rare co-existance of disease or pathology Primary angle closure (PAC) is common in hyperopic eyes, but it is rarely observed in highly myopic eyes. Myopic eyes have a longer axial length and a deeper anterior chamber compared with emmetropic eyes and are con-sidered to be protected from angle closure secondary to pupillary block. PAC can lead to irreversible loss of vi-sion if left untreated. Hence, detection of these atypical cases is important to prevent the permanent sequel-ae associated with PAC. We present a case of acute attack of PAC in a patient with high axial myopia. A 53-year-old woman with di-abetes presented to the Emergency Department with a 1-week history of pain and redness in the right eye. Ophthalmic examination revealed a high intraocular pressure of 40 mm Hg associated with shallowing of the anterior chamber peripherally in the right eye. The patient’s spherical equivalent was-11.00 diopters in the right eye. Gonioscopy confirmed the presence of a 360° appositional closure of the iridocorneal angle. An acute attack of PAC was diagnosed, and the intraocular pressure was decreased using topical and systemic antiglau-coma medications. Laser peripheral iridotomy was performed to abort the acute attack. Although PAC is unusual in highly myopic eyes, ophthalmologists should maintain a high level of suspicion when such atypical cases are encountered. Myopic refraction does not exclude the possibility of angle closure, and gonioscopy should therefore be performed on all patients at the initial assessment.