Post-Operative Delirium Masking Acute Angle Closure Glaucoma

• Published in: Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) Vol. 9; no. 3; pp. 187 - 191
• Main Authors: Sim, Zariel Jiaying, Jieyin, Xing, Suhitharan, Thangavelautham
• Format: Report
• Language: English
• Published: 01.07.2023
• DOI: 10.2478/jccm-2023-0016
• ISSN: 2393-1809

IntroductionAcute angle closure glaucoma (AACG) is an ophthalmological emergency, and can lead to the devastating consequence of permanent vision loss if not detected and treated promptly. We present a case of an atypical presentation of unilateral AACG on post operative day (POD) 1, after a prolonged operation under general anaesthesia (GA). Case presentationA 65-year-old female underwent a 16 hour long operation for breast cancer and developed an altered mental status with a left fixed dilated pupil on POD 1. She was intubated to secure her airway in view of a depressed consciousness level and admitted to the intensive care unit. Initial blood investigations and brain imaging were unremarkable. On subsequent review by the ophthalmologist, a raised intraocular pressure was noted and she was diagnosed with acute angle closure glaucoma. She was promptly started on intravenous acetazolamide and pressure-lowering ophthalmic drops. Her intraocular pressure normalized in the next 24 hours with improvement in her mental status to baseline. ConclusionAACG needs to be consistently thought of as one of the top differentials in any post-operative patient with eye discomfort or abnormal ocular signs on examination. A referral to the ophthalmologist should be made promptly once AACG is suspected.