Acute primary angle closure presents with a painful red eye, blurred vision, coloured halos around lights, headache and often nausea or vomiting — which can lead to it being mistaken for migraine or a gastrointestinal illness. The cornea is hazy and the pupil mid-dilated and poorly reactive.
Primary angle closure is common in Asian populations, including in India. Measure intraocular pressure if possible, do not dilate the pupil, and refer the same day for pressure lowering and laser iridotomy.
- Suspect angle closure in any red painful eye with halos, headache or vomiting.
- Check for a hazy cornea and a mid-dilated, poorly reactive pupil.
- Do not instil dilating drops.
- Refer the same day; the fellow eye also needs assessment for prophylactic laser iridotomy.
Why it matters
Vomiting and headache send many of these patients to a physician first, and delay costs vision.
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