—We concur with Dr Smith that another mechanism might have played a role in our case, but we hesitate to rule out acute hyperglycemia as a contributory cause. Angle closure glaucoma is probably multifactorial in origin, and some of the precipitating factors are still unknown. Simultaneous, bilateral angle closure glaucoma is extremely rare, and there is good reason to suspect some systemic cause as a contributory factor. We invoked acute hyperglycemia because evidence exists to confirm that hyperglycemia of the degree noted in our patient (180 mg/dL [10.0 mmol/L]) was high enough for the lens sorbitol pathway to become activated.1 In addition, significant osmotic changes in the lens have been demonstrated at that blood glucose level.2 The only way we could have "proved" that hyperglycemia was indeed causally related to angle closure glaucoma was to have resolved the angle closure glaucoma and hyperglycemia medically and then
Wand M. Angle Closure Glaucoma and Acute Hyperglycemia-Reply. Arch Ophthalmol. 1987;105(4):454–455. doi:10.1001/archopht.1987.01060040024006
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