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Acute angle-closure glaucoma — SCE Acute Medicine MCQ

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EasyAcute Neurological PresentationsAcute angle-closure glaucomaSCE Acute Medicine

A 34-year-old woman presents with acute neurological symptoms. Relevant history includes vascular, infectious or neuromuscular risk factors. On assessment, neurological examination shows focal or global dysfunction. Investigations show painful red eye, fixed mid-dilated pupil and high intraocular pressure. What is the most appropriate next step in management?

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Correct answer: C — Refer urgently to ophthalmology with pressure-lowering treatment

The key discriminator is that painful red eye, fixed mid-dilated pupil and high intraocular pressure, which makes Refer urgently to ophthalmology with pressure-lowering treatment the single best answer. Provide supportive care and close monitoring is less appropriate because it does not address the dominant acute risk in the vignette; Give controlled oxygen and senior review would fit a different presentation or later stage of care. Optimise chronic medication and discharge and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Royal College of Ophthalmologists guidance