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Lee NSY, Woo TL, Agar A, Francis IC. Acute angle closure glaucoma misdiagnosed as sinusitis. Pract Neurol 2023; 23:527-529. [PMID: 37679039 DOI: 10.1136/pn-2023-003864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
A 69-year-old woman developed severe right suprabulbar pain with blurred right-sided vision. There were no haloes around lights, photophobia, nausea or vomiting. Investigations in the emergency department excluded a posterior communicating/internal carotid artery aneurysm. However, she did not have an ophthalmological assessment and the initial diagnosis was of sinusitis-related headache. An urgent ear, nose and throat assessment found no abnormality, but a local ophthalmologist subsequently diagnosed and managed the patient's acute angle closure crisis. Periocular pain always deserves detailed assessment with an accurate history, visual acuity assessment and intraocular pressure measurement.
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Affiliation(s)
- Natalie Si-Yi Lee
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas L Woo
- Chatswood Eye Specialists Clinic, Sydney, New South Wales, Australia
| | - Ashish Agar
- University of New South Wales, Sydney, New South Wales, Australia
- Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Ian C Francis
- University of New South Wales, Sydney, New South Wales, Australia
- Chatswood Eye Specialists Clinic, Sydney, New South Wales, Australia
- Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
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Lee BWH, Lau FS, Wong EL, Lam D, Francis IC. Lessons From Management: Perioperative Phacoemulsification Planning Following Resolution of Acute Angle Closure. Cureus 2021; 13:e14331. [PMID: 33972892 PMCID: PMC8105251 DOI: 10.7759/cureus.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with loose zonular apparatus after acute angle closure may require phacoemulsification cataract surgery. The authors' experience from management of such patients provides excellent instruction on the surgical intervention for their cataracts. This is because patients who have recovered from acute angle closure glaucoma may not have evident zonular laxity preoperatively, as the iris may be taut secondary to the effects of associated ischaemia. If the surgeon’s preoperative planning is directed to the possibility of loose zonular apparatus, then appropriate preoperative, intraoperative, and postoperative planning and management can be effected. This may permit preoperative patient counselling regarding the potentially increased complexity of the case. Intraoperatively, deliberately gentle capsulorrhexis, the use of iris hooks or a pupil expander to dilate the pupil, iris hooks to support the capsular bag, and the employment of a capsular tension ring may be helpful. Postoperatively, due to the previous ocular ischaemia, intraocular pressure elevation may ensue, and should be actively managed. The authors provide a summary of factors that require consideration in patients undergoing cataract surgery following acute angle closure.
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Affiliation(s)
- Brendon W H Lee
- Faculty of Medicine, University of New South Wales, Sydney, AUS.,Ophthalmology, Prince of Wales Hospital, Sydney, AUS
| | - Fiona S Lau
- Faculty of Medicine, University of New South Wales, Sydney, AUS.,Ophthalmology, Prince of Wales Hospital, Sydney, AUS
| | - Elizabeth L Wong
- Faculty of Medicine, University of New South Wales, Sydney, AUS.,Ophthalmology, Prince of Wales Hospital, Sydney, AUS
| | - Danny Lam
- Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, AUS
| | - Ian C Francis
- Faculty of Medicine, University of New South Wales, Sydney, AUS.,Ophthalmology, Prince of Wales Hospital, Sydney, AUS.,Ophthalmology, Chatswood Eye Specialists, Sydney, AUS.,Ophthalmology, Chatswood Private Hospital, Sydney, AUS
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