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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 68-year-old woman presents with severe unilateral eye pain, blurred vision, headache and vomiting. The right eye is red with a mid-dilated fixed pupil and hazy cornea. Blood pressure is 156/86 mmHg and neurological examination is normal. What is the most likely diagnosis?

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Correct answer: E — Acute angle-closure glaucoma

Painful red eye with blurred vision, vomiting, hazy cornea and mid-dilated fixed pupil is acute angle closure glaucoma. Migraine and cluster headache do not cause the same corneal haze and fixed pupil. Uveitis causes photophobia and ciliary injection but not this classic pressure picture. The pearl is that acute glaucoma is an ophthalmic emergency that can present as headache and vomiting.

Reference: Royal College of Ophthalmologists emergency eye care guidance