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Re: Systemic manifestations of acute glaucoma in the elderly

Dear Editor,

We read with interest the case report published by Gandhewar RR and colleagues (1).

From September 05- November 05 we have seen three elderly female patients aged between 70 - 90 years presented to the emergency medicine department with sudden onset of unilateral headache, hypertension and profuse vomiting. They did not have any focal neurological deficit. The patients were examined by junior doctors initially and thought have been suffering from acute intracranial event and had requested CT scans.

What was interesting to note was that none of the patients complained of any visual disturbances unless particularly asked? They answered that the vision was hazy in that particular eye. None of the patients had a classical red eye; it was more of a mild conjunctival injection. The only consistent finding other than the systemic symptoms were that they all had a mid size pupil with minimal or no reaction to light and eye itself was hard to touch.

All three patients had a diagnosis of acute angle closure glaucoma (AACG) made in the emergency department. This was confirmed by ophthalmologists. All made complete recovery following treatment.

The systemic symptoms in these patients are said to arise from excessive vagal stimulation. Although the condition is more common in certain ethnic groups such as Asians and African Americans, in our group all three patients were Caucasian.

It is also important to note that the key to preventing visual loss from glaucoma is early diagnosis and treatment. Due to increased awareness created by this article, 3 patients in our hospital had just that.

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