DR. NITHILA E. G. PAUL

DR. NEETHU MOHAN, DR. MADHURI MANAPAKKAM BUTCHI

Abstract

37-year-old female had acute exacerbation of COPD after flu vaccination. She was treated with oxygen, nebulization and intravenous medications. She had sudden onset headache with blurred vision and was investigated. On diagnosing acute angle closure, medications were started and YAG PI was attempted. As it was bilateral, to rule out secondary causes, UBM was done. There was no choroidal effusion. We diagnosed secondary angle closure probably drug induced -nebulized salbutamol with ipratropium bromide. These drugs, when combined, cause pupillary block. In the right eye, PI was patent and IOP was controlled with drops. However, in the left eye IOP was high with lamellar PI. Glaucoma progressed despite maximum medical therapy. IOP was controlled after she underwent trabeculectomy with mitomycin C.

It is imperative to know the exact mechanism of angle closure in cases such as this, as the management varies. This case highlights that certain drugs can precipitate acute angle closure.