A case of bilateral acute angle closure glaucoma secondary to systemic decongestants

Abstract

AbstractPurposeTo report a case of bilateral acute angle closure attack secondary to an oral decongestant and antihistamine use.MethodsA case report.ResultsA 42‐year‐old Chinese lady with no past medical or ocular history presented to the Emergency Department with a 2‐day history of headache, vomiting and bilateral eye redness. She had taken pseudoephedrine and chlorpheniramine the previous 5 days for cold symptoms. Best‐corrected visual acuity (BCVA) was 6/24 bilaterally. Her intraocular pressure (IOP) was 37 (right) and 39 (left) mmHg. On slit lamp examination, the corneas were hazy and edematous with mid‐dilated pupils. Gonioscopy revealed closed angles bilaterally. Glaukomflecken was noted on both lenses. A diagnosis of bilateral acute angle closure attack was made. She was immediately given intravenous acetazolamide and topical hypotensive drops (timolol 0.5%, brimonidine 0.1%, prednisolone acetate 1% and pilocarpine 2%) followed by oral acetazolamide and continuation of all the topical drops. 9 hours later, the BCVA had improved to 6/15 (right) and 6/9.5 (left). Her left cornea was clearer but right was still hazy. IOP was 32 (right) and 14 (left) mmHg. B‐scan ultrasound showed no choroidal thickening. Subsequently, a bilateral laser iridoplasty was performed followed by laser iridotomy. Her IOP normalized after the procedures to 8 mmHg in both eyes.ConclusionsSeveral systemic medications are known to precipitate angle closure glaucoma. It is important to counsel patients on risks and symptoms before initiating these seemingly benign medications for a common cold.