Acute primary angle closure often presents outside the eye clinic, to an emergency department or a GP, as severe headache, nausea and vomiting with a red, painful eye and blurred vision. Patients may describe haloes around lights. The pupil is often mid-dilated and poorly reactive, the cornea hazy, and the eye feels hard. It is an emergency: pressure needs lowering within hours to protect the optic nerve, and the other eye is at risk too.
- Examine the eyes in any patient with severe headache and vomiting plus a red eye or blurred vision.
- Look for a mid-dilated, poorly reactive pupil and a hazy cornea.
- Refer the same day to an eye service; do not wait for a routine appointment.
- Avoid dilating drops in anyone with suspected angle closure.
Why it matters
Mistaking it for migraine or gastroenteritis can cost permanent vision within hours.
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