Case 2

Patient History

A 62-year-old female presents to the emergency department complaining of severe, throbbing pain in her right eye that began two hours ago. She describes the pain as “unbearable” and mentions it radiates to her forehead. The onset was sudden, occurring while she was watching a movie in a darkened theater.

She reports blurred vision in the affected eye and sees rainbow-colored halos around lights. Accompanying the ocular symptoms, she has experienced significant nausea and two episodes of vomiting. She denies any recent trauma to the eye or similar previous episodes.

Physical Examination Findings

Visual Acuity:

• Right Eye (OD): 6/60 (reduced, does not improve with pinhole)
• Left Eye (OS): 6/9

External Examination (OD):

• Lids: Mild edema.
• Conjunctiva: Marked ciliary congestion (circumcorneal injection).
• Cornea: Appears hazy and “steamy” due to epithelial edema.
• Anterior Chamber: Extremely shallow; the peripheral iris appears to be in contact with the corneal endothelium.
• Pupil: Vertically oval, mid-dilated, and non-reactive to light.

Intraocular Pressure (IOP):

• OD: 58 mmHg (Severely elevated; globe feels “stony hard” on digital palpation)
• OS: 16 mmHg (Within normal limits)

Slit Lamp & Fundoscopy:

• OD: Details of the fundus are difficult to visualize due to corneal edema, but the optic disc appears hyperemic.
• OS: Deep anterior chamber; normal optic disc with a cup-to-disc ratio of 0.3.

Gonioscopy (Contralateral Eye):

• Reveals a narrow, occludable angle (Shaffer Grade 1), suggesting a dynamic predisposition to closure.