Updated 24 March 2015

Answer: What's your diagnosis? – Case 2

In our second mystery case, Mrs P suffered acute angle-closure glaucoma, an ophthalmological emergency, when she experienced a sudden onset severe pain in her right eye and bright halos.


Read about Mrs P's presenting problems in the original case study here.

Mrs P is suffering from a condition called acute angle-closure glaucoma.  In this condition, a sudden increase in the pressure inside the eyeball causes a severe one-sided eye pain with a loss of vision.

What causes acute glaucoma?

This type of glaucoma is caused by acute obstruction of the drainage of the fluid in the eye – the aqueous humour. This is usually due to an anatomic abnormality of the eye in which the front part (anterior chamber) is shallow. This occurs most commonly in an older person who is long-sighted. 

Numerous factors can precipitate this condition. It is usually brought on by a partial dilation of the pupil which blocks the drainage of the fluid out of the front chamber of the eyeball. 

This partial dilation of the pupil may be due to a range of medication (anxiety, depression and allergy medication), poor light or even fear or a fright.

Symptoms and signs

Symptoms include:

1.  Severe, sudden onset eye pain
2.  Nausea and vomiting are common
3.  Decrease in vision
4.  Bright halos around objects are occasionally noted

On examination, the eye is engorged and red – visibly swollen. The surface of the cornea is dull. The pupil does not respond to differences in light – fixed and non-reactive – is semi-dilated and often slightly oval in shape.


The initial treatment is to lower the intraocular pressure and to constrict the pupil to protect the optic nerve. 

A range of medication can be used to lower the pressure the affected eye, but surgery remains the definite treatment in a procedure called and iridotomy. The treating doctor will in consultation with you decide on the best treatment plans.


This disease can be prevented if an eye at risk undergoes a minor laser procedure called a laser iridotomy.

When to see your doctor

You need to see a doctor immediate in the case of:
1.  severe, sudden onset eye pain with decreased vision.
2.  any painful red eye should be examined by a doctor.

Image: Older woman suffering from headache from Shutterstock

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.


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