05/28/2026
👉This week’s eye disease case involves a new patient who was seemingly healthy middle-aged man who came in on the memorial’s day, Monday May 25th, complaining of a possible foreign body in his eye, with symptoms including irritation, sensitive to lights, blurry vision and pain in the left eye for one week.
Prior to the onset of severe symptoms, he experienced some eye irritation and attempted to flush out the potential foreign body with water before going to sleep. The next morning, he woke up with significant vision blurriness and pain, prompting a visit to urgent care, where antibiotic eye drops were prescribed along with a follow-up appointment.
Despite treatment, his condition deteriorated, resulting in loss of vision in the left eye. He was told to see the eye specialist. He had attempted to get the same day appointment with the local specialist in town, but unable to secure a timely appointment so somehow he called our office and we took him in to see our doctor right away because saving one’s eyesight is always our priority. He presented to our office for evaluation. The examination found no evidence of corneal foreign body or infection but revealed severe corneal edema with endothelial folds, a mid-dilated pupil, with posterior synechia, and a complete 360-degree angle closure. His intraocular pressure (IOP) was above 60 iand his other eye was read 16 (normal IOP is 10-20mmHg).
His aided visual acuity was 20/50 in the right eye and hand motion in the left eye. His last eye exam was about 5 years ago.
Patient was instructed to discontinue the antibiotics eye drops that he was currently taking because they didn’t help his conditions. He was immediately prescribed several different eye drops to lower the IOP and to reduce the corneal edema. Patient returned a few hours later for follow up in the morning and his IOP dropped under 50 and his corneal edema improved but his vision was still blurry. He then sent to pick up additional prescription, oral meds at his pharmacy and instructed patient to take them right away, a few hours apart and return in the afternoon before 5pm for another IOP reading. He came back around 4:50pm that same day and his IOP was dropped below 40. At this time, patient reported having improved in his vision and comfort. Patient was instructed to keep taking eye drops and oral meds, then he returned in 2 days for another follow up. Two days later, he came in for his follow up and his vision improved 20/80 and his IOP dropped to 17 (normal range).
☀️glaucomatous crisis is a sudden and dangerous rise in intraocular pressure (IOP) that can rapidly damage the optic nerve and threaten vision if not treated promptly. The most classic form is acute angle-closure glaucoma, though severe pressure spikes can also occur in other glaucoma conditions.
Differential Diagnosis😎
* Uveitic glaucoma
* Phacolytic glaucoma
* Neovascular glaucoma
* Posner–Schlossman syndrome
* Malignant glaucoma
Common Symptoms
* Severe eye pain
* Red eye
* Blurred or foggy vision
* Halos around lights
* Headache
* Nausea and vomiting
* Mid-dilated poorly reactive pupil
* Corneal edema (“steamy” cornea)
Clinical Findings
* Markedly elevated IOP (often >40–50 mmHg)
* Shallow anterior chamber
* Closed or narrow angle on gonioscopy
* Conjunctival injection
* Corneal haze from edema
Risk Factors
* Hyperopia
* Narrow anatomical angles
* Older age
* Asian ethnicity
* Stress or dim lighting
* Certain medications causing pupillary dilation
👀Management often includes urgent IOP reduction with topical and systemic agents, gonioscopy evaluation, and typically laser peripheral iridotomy once pressure and corneal clarity improve.
😎In past years, our office was closed on this day, along with many local medical offices. However, this year, we made an exception and opened our clinic to care for our patients. We were grateful to be available to evaluate and treat this patient during an acute ocular emergency, where timely intervention was critical to preserving vision.
The image below was not our patient’s eye but it was very similar. Key visible findings:
-Corneal edema causing a “steamy” or cloudy cornea
-Sgnificant circumlimbal/conjunctival redness
-Mid-dilated poorly reactive pupil appearance
-Elevated intraocular pressure
Note: Patient information has been de-identified for educational purposes.
☀️Although this case represented a true ocular emergency and an uncommon presentation, we are thankful for the trust this patient placed in our office for his eye care needs. We also appreciate his commitment to following through with the recommended treatment plan, which is essential in managing vision-threatening conditions and achieving the best possible outcome.
Sources:
Tracey H. Nguyen, O.D.
Vision Care Optometry of Hanford
David E. I. Pyott Glaucoma Education Center
American Academy of Ophthalmology
