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A Convergence of Ophthalmic and Life-threatening Emergencies

Acute Angle Closure Glaucoma and Subarachnoid Hemorrhage

Sobol, Ethan K. MD*,†; Carter, Kaylene L. MS; Ibrahim, Kirolos MD*,†; Alfaro, Cesar MD*,†; Patel, Ekta MD*,†; Pasquale, Louis R. MD*,†; Tung, Cynthia MD*,†

doi: 10.1097/IJG.0000000000001310
Online Articles: Case Report/Small Case Series

Purpose: To report a unique case of acute angle closure glaucoma in the setting of a subarachnoid hemorrhage due to a ruptured cerebral aneurysm.

Materials and Methods: Observational case report and review of the literature.

Results: A 75-year-old woman presented with blurry vision, nausea, vomiting, and left eye pain. She was found to have a complete third nerve palsy, with ptosis, exotropia, hypotropia, and a fixed mydriasis with resultant acute angle closure glaucoma. Pilocarpine was initiated, and neuroimaging revealed a subarachnoid hemorrhage from a ruptured posterior communicating artery aneurysm. The aneurysm was successfully coiled, and outpatient laser iridotomies were subsequently performed. Only 4 prior cases of acute angle closure glaucoma in the setting of a third nerve palsy have been reported in the literature. To our knowledge, this case is the first report of angle closure glaucoma in the setting of a subarachnoid hemorrhage.

Conclusions: This case of a complete third nerve palsy in the setting of a subarachnoid hemorrhage leading to acute angle closure highlights the importance of ruling out this life-threatening diagnosis when neurological signs of increased intracranial pressure and cranial nerve palsies are present.

*Department of Ophthalmology, Icahn School of Medicine at Mount Sinai

New York Eye and Ear Infirmary of Mount Sinai, New York, NY

Stanford University School of Medicine, Stanford, CA

Disclosure: The authors declare no conflict of interest.

Reprints: Ethan K. Sobol, MD, The Mount Sinai Hospital, Ophthalmic Consultation Suite, 1468 Madison Avenue, Intake #4, New York, NY 10029 (e-mail:

Received June 4, 2019

Accepted June 9, 2019

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