A Man With Painful Loss of Vision

Abstract

An 82-year-old man with a history of a stroke and chronic left glaucoma presented to the emergency department with nontraumatic increasing pain in his left eye and epiphora persisting for 4 days. Although he reported that he could count fingers before this deterioration, he could currently only distinguish between light and dark. He was treated with anticoagulant rivaroxaban. On examination, his left sclera was reddened, and his pupil was reactive. The intraocular pressure was 12 mmHg in the unaffected eye and 45 mmHg in the affected eye, and the emergency physician deferred bedside ultrasonography in favor of computed tomography.