Clinical Clues for the Early Diagnosis of Acute Primary Angle-Closure Glaucoma: A Case Report

Acute primary angle closure glaucoma (APACG) is a vision-threatening ophthalmic emergency characterized by sudden obstruction of aqueous humor outflow, resulting in a rapid elevation of intraocular pressure (IOP) that may cause irreversible optic nerve damage if not promptly treated. We report the case of a 50-year-old man who presented with sudden blurred vision in the left eye accompanied by severe ocular pain radiating to the ipsilateral head, conjunctival redness, photophobia, colored halos around lights, nausea, and vomiting. Ophthalmic examination revealed markedly reduced visual acuity (1/300), conjunctival ciliary injection, diffuse corneal edema, a shallow anterior chamber, a positive shadow test, a mid-dilated pupil with reduced light reflex, and an IOP of 62 mmHg in the affected eye. Posterior segment ultrasonography demonstrated no significant abnormalities. Based on the characteristic clinical presentation and ophthalmic findings, a diagnosis of acute primary angle closure glaucoma was established. Initial medical therapy with topical antiglaucoma medications, topical corticosteroids, systemic corticosteroids, analgesics, and antihypertensive treatment was administered, followed by definitive management with laser peripheral iridotomy. The patient experienced marked symptomatic improvement after treatment and was scheduled for regular followup. This case highlights the importance of early recognition of the classical clinical manifestations of APACG and demonstrates that careful history taking combined with comprehensive basic ophthalmic examination remains sufficient for establishing a timely diagnosis and initiating sight-saving treatment, particularly in resource-limited clinical settings where advanced imaging modalities may not be immediately available.