Vision: (previous R and L 6/9) R 6/9 L 6/60.
IOPs: R 20mmHg (Perkins@9.45am) L 55mmHg.
Ocular examination:
?e_SQuSRight pupil normal size 4mm, reacting normally to direct, consensual and near reflexes
?e_SQuSLeft pupil fixed, slightly dilated and unreactive to light reflex
?e_SQuSCornea oedematous
?e_SQuSConjunctival blood vessels engorged
?e_SQuSCrystalline lens had unchanged cortical cataracts bilaterally.
OCT anterior assessment:
?e_SQuSBlocked left filtration angle (Figure 1)
?e_SQuSCorneal oedema - corneal thickness 592 microns and cystic changes seen to the right of white line on the infra-red corneal image (Figure 2)
?e_SQuSNarrow right eye angle.
Ophthalmological/medical treatment:
The patient was referred urgently to the eye clinic with a letter and a phone call to the ophthalmologist. He was seen straight away and pilocarpine eye drops applied to constrict the left pupil and Diamox (acetazolamide) tablets given. This carbonic anhydrase inhibitor effectively reduced the IOP. A catheter was also inserted, while he waited for his next set of drops, to ease his urination problems. Three hours later both eyes had laser iridotomy.
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