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JAMA Ophthalmology Clinical Challenge
September 2013

Acute Bilateral Angle Closure

Author Affiliations
  • 1Glaucoma Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
  • 2Glaucoma Service, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
JAMA Ophthalmol. 2013;131(9):1231-1232. doi:10.1001/jamaophthalmol.2013.5186

A 30-year-old woman with a history of migraine headaches presented to our emergency department with the sudden onset of blurred vision and a frontal headache. She reported a normal eye examination by an optometrist 6 months prior and no history of corrective lens wear. Her visual acuity without correction in each eye was count fingers at 5 ft with pinhole improvement to 20/200. The pupils were 4 mm OU and unreactive. On slitlamp examination, the anterior chambers were shallow and the angles on gonioscopy were closed in each eye (Figure). The undilated fundus examination revealed normal-appearing optic nerves with cup-to-disc ratios of 0.2. Intraocular pressures were 48 mm Hg OD and 49 mm Hg OS. When given a −6.50 D sphere trial lens, her visual acuity improved to 20/20 OD and 20/25 OS. When asked about her medications, she reported that she recently discontinued a medication for migraine headaches.

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