What are the key clinical features that suggest a diagnosis of acute angle-closure glaucoma in a patient presenting with eye pain?

Key clinical features suggesting acute angle-closure glaucoma in a patient presenting with eye pain include:

• Sudden onset of severe eye pain, often accompanied by headache.
• Visual disturbance such as blurred vision or halos around lights.
• Red eye due to conjunctival injection.
• Mid-dilated, non-reactive pupil on examination.
• Raised intraocular pressure (IOP) typically measured by Goldmann applanation tonometry.
• Shallow anterior chamber on slit lamp examination or peripheral anterior chamber depth assessment (e.g., van Herick test or gonioscopy).
• Nausea and vomiting may also be present due to the acute rise in IOP.

These features warrant urgent ophthalmic assessment and management to prevent permanent visual loss.

Note: While the NICE guideline NG81 focuses primarily on chronic open angle glaucoma diagnosis and management, it emphasizes the importance of assessing anterior chamber depth and IOP, which are critical in diagnosing angle-closure glaucoma. Gonioscopy or van Herick test is essential to confirm angle closure in suspected cases presenting with acute symptoms ¹.