J Korean Ophthalmol Soc.  2021 May;62(5):724-728. 10.3341/jkos.2021.62.5.724.

Nonarteritic Anterior Ischemic Optic Neuropathy Accompanying Appositional Angle-closure Glaucoma Mimicking Glaucomatocyclitic Crisis

• Jung DH
• Lee SJ

• KMID: 2515959
• DOI: http://doi.org/10.3341/jkos.2021.62.5.724

Abstract

Purpose
We report a case of nonarteritic anterior ischemic optic neuropathy (NAION) in a high hyperopia and appositional angle closure glaucoma (AACG) patient mimicking glaucomatocyclitic crisis.
Case summary
A 57-year-old man presented with headache, ocular pain, and visual disturbance in the right eye for 3 days. There was no past medical history. The best corrected visual acuity was 0.02 and the intraocular pressure (IOP) was 30 mmHg in the right eye. Refractive errors were +7.25 diopters in the right eye. Slit-lamp examination revealed corneal edema, anterior chamber (AC) inflammation (+1), 6 mm-dilated fixed pupil, and >1/4 peripheral AC depth in the right eye. Fundus examination revealed optic disc swelling, and visual fields test demonstrated inferior altitudinal field defects in the right eye. Glaucomatocyclitic crisis and NAION in the right eye were diagnosed. Topical anti-glaucoma eyedrops and intravenous steroid were administered. IOP was not controlled and then, gonioscopy revealed a grade 1 360° B10s appositional angle closure on Shaffer classification in the right eye. Laser iridotomy was performed. IOP increasement, ocular pain of the right eye, and headache disappeared. After 1 month later, fundus examination revealed an improved optic disc swelling and 0.4 cup-to-disc ratio in the right eye. The visual acuity in the right eye didn’t improve after 3 months.
Conclusions
NAION may occur in AACG patient with high hyperopia even if there is no underlying systmemic disease or small cup-to-disc ratio.

Keyword

Angle closure glaucoma, Anterior ischemic optic neuropathy, Hyperopia