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Abstract
Purpose
The authors report a case of bilateral simultaneous acute angle closure attack following administration of an over-the-counter common cold medication (ingredients: chlorpheniramine maleate, phenylephrine hydrochloride, and belladonna alkaloid).
Case summary
A 67-year-old man visited the emergency room with a sudden onset of bilateral blurred vision and ocular pain accompanied by headache, nausea, and vomiting. He had taken an over-the-counter common cold medication three times per day for three days before the visit. His visual acuity was 0.3 and 0.7 and intraocular pressure (IOP) was 50 mm Hg and 40 mm Hg in right and left eye, respectively. The refraction in manifest refractive test was +0.75 D sph = ‑0.75 D cyl × 100 in right eye and +1.25 D sph = ‑1.25 D cyl × 80 in left eye. The anterior chamber depth was three times the corneal thickness in center and less than 1/4 of the corneal thickness in periphery in both eyes on van Herick method. The angles of both eyes were closed on gonioscopy. He was treated with ocular hypotensive medication and miotics followed by withdrawal of common cold medications. After 10 days, bilateral neodymium-doped yttrium aluminium garnet (Nd:YAG) laser peripheral iridotomies were done. During four months of follow-up, there was no recurrence of angle closure attack, and normal IOP was maintained without glaucoma medications.
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Figure 1.
Anterior segment photograph findings 4 months after angle closure attack. (A) Right eye. (B) Left eye. Nd:YAG laser iridotomy was done on both eyes 10 days after angle closure attack. The iridotomy sites are shown in red dotted circles and sector iris atrophies are shown near the pupil in both eyes. Nd:YAG = neodymium-doped yttrium aluminium garnet.
Figure 2.
Humphrey visual field analysis (A: right, B: left), retinal nerve fiber layer optical coherence tomography (C: right, D: left) and red-free fundus photograph (E: right, F: left) which were examined 6 weeks after angle closure attack. The results did not show glaucomatous damages in both eyes.
Figure 3.
Anterior segment photographs of anterior chamber 4 months after angle closure attack (A, C: right eye, B, D: left eye). Both right eye (A: center, C: peripheral) and left eye (B: center, D: peripheral) show 3 corneal thickness deep centrally and less than 1/4 corneal thickness deep peripherally.
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