BILATERAL ACUTE ANGLE CLOSURE GLAUCOMA IN A COVID 19 PATIENT FOLLOWING HEPARIN THERAPY- A CASE REPORT

Abstract

Acute angle closure glaucoma is an ophthalmic emergency and can lead to blindness if left untreated. Pupillary block is the most common mechanism. Drug induced angle-closure has been reported to cause a significant proportion of these cases particularly in developing countries. The common drugs implicated are antidepressants, antipsychotics, antihistamines, anticonvulsants like topiramate, sulfa based drugs namely acetazolamide and hydrochlorothiazide, nebulized ipratropium bromide and salbutamol. Anticoagulants have also been reported to cause AACG in predisposed eyes As the COVID-19 pandemic has spread throughout the world, a high rate of thrombotic complications has been described, including deep vein thrombosis Although the mechanisms of thrombosis are unclear, anticoagulation with high doses of heparin has been proposed for these patients. Critically ill patients with COVID-19 develop life-threatening coagulopathy and thromboembolic complications that justify aggressive anticoagulation with close monitoring. We report a patient who developed bilateral angle closure glaucoma following heparin therapy who was misdiagnosed as having conjunctivitis by treating physicians which is an ocular manifestation of COVID 19.