A Convergence of Ophthalmic and Life-threatening Emergencies: Acute Angle Closure Glaucoma and Subarachnoid Hemorrhage. Issue 9 (September 2019)

• Record Type: Journal Article
• Authors: Sobol, Ethan K.; Carter, Kaylene L.; Ibrahim, Kirolos; Alfaro, Cesar; Patel, Ekta; Pasquale, Louis R.; Tung, Cynthia
• Is Part Of: Journal of glaucoma. Volume 28:Issue 9(2019)
• Publication Date: 2019-09
• Subjects: angle-closure glaucoma -- subarachnoid hemorrhage -- third nerve palsy -- posterior communicating artery aneurysm; Glaucoma -- Periodicals; 617.741005
• DOI: 10.1097/IJG.0000000000001310
• Languages: English
• ISSNs: 1057-0829

Abstract

Abstract : Purpose: To report a unique case of acute angle closure glaucoma in the setting of a subarachnoid hemorrhage due to a ruptured cerebral aneurysm. Materials and Methods: Observational case report and review of the literature. Results: A 75-year-old woman presented with blurry vision, nausea, vomiting, and left eye pain. She was found to have a complete third nerve palsy, with ptosis, exotropia, hypotropia, and a fixed mydriasis with resultant acute angle closure glaucoma. Pilocarpine was initiated, and neuroimaging revealed a subarachnoid hemorrhage from a ruptured posterior communicating artery aneurysm. The aneurysm was successfully coiled, and outpatient laser iridotomies were subsequently performed. Only 4 prior cases of acute angle closure glaucoma in the setting of a third nerve palsy have been reported in the literature. To our knowledge, this case is the first report of angle closure glaucoma in the setting of a subarachnoid hemorrhage. Conclusions: This case of a complete third nerve palsy in the setting of a subarachnoid hemorrhage leading to acute angle closure highlights the importance of ruling out this life-threatening diagnosis when neurological signs of increased intracranial pressure and cranial nerve palsies are present. Abstract : Supplemental Digital Content is available in the text.