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A 35-year-old woman presenting with pain, reduced right-eye vision, and headache
Digital Journal of Ophthalmology 2015
Volume 21, Number 2
May 13, 2015
DOI: 10.5693/djo.03.2015.03.002
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Brinda P. Shah, MS, FRCOphth | Moorfields Eye Hospital, London, United Kingdom
Jonathan Clarke, MD, FRCOphth | NIHR Biomedical Research Centre at Moorfields Eye Hosital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
The acute pupillary block was managed with systemic and topical hypotensives (acetazolamide 250 mg and apraclonidine 0.5% eyedrops [apraclonidine was used because of its rapid onset of action]). Pupil dilation was achieved with atropine 1% eyedrops, thus relieving the pupil’s compression of the vitreous at the pupil margin. The patient was laid supine to encourage backward displacement of the vitreous. Her IOP decreased to 40 mm Hg in an hour and to 9 mm Hg by the next morning. She then underwent an urgent surgical iridectomy and anterior vitrectomy. One week postoperatively, her visual acuity returned to the previous best-corrected Snellen visual acuity of 6/36, and the IOP was normal. The iris contour had become flat and the iridocorneal angles were open, as demonstrated by the anterior segment optical coherence tomography (Figure 1B). At final follow-up, 20 months after surgery, she has not suffered any further episodes of headaches or visual aura.