Acute angle-closure glaucoma is often first seen by a GP or emergency doctor, and can be mistaken for migraine, conjunctivitis or a gastrointestinal illness because of headache, nausea and vomiting. The eye is red, painful and the vision blurred, often with haloes around lights; the cornea looks hazy and the pupil is fixed or sluggish and mid-dilated.
The eye feels hard to gentle palpation compared with the other. This is a same-day ophthalmic emergency. Start pressure-lowering treatment as advised by the eye service, and avoid dilating drops in anyone with suspected narrow angles.
- Consider angle closure in any older adult with a red, painful eye, blurred vision and vomiting.
- Look for a hazy cornea and a mid-dilated, poorly reactive pupil.
- Refer the same day to ophthalmology.
- Avoid dilating drops when angle closure is suspected.
Why it matters
Delay in recognising acute angle closure can mean permanent loss of vision within hours to days.
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