What are the physical exam findings in acute angle-closure glaucoma (AACG)?

Updated: Nov 19, 2018
  • Author: Joseph Freedman, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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The emergency department evaluation of the eye includes visual acuity, the external eye, visual fields, a funduscopic examination, pupils, ocular motility, and IOP. All of these tend to be affected in AACG.

Slit-lamp evaluation may reveal corneal edema, synechiae, irregular pupil shape or function, or segmental iris atrophy.

Patients complain of blurred vision, and testing reveals decreased visual acuity in the affected eye, often the ability to detect hand movements only. Commonly, they are unable to identify numbers and letters on distance charts or near cards.

Cornea and scleral injection and ciliary flush are present. The obviously edematous and cloudy cornea obscures the funduscopic examination.

Increased IOP (normal limit, 10-20 mm Hg) and ischemia result in pain on eye movement, a mid-dilated nonreactive pupil, and a firm globe. Clinicians must take a comprehensive history and perform a thorough physical examination to ensure that this time-sensitive diagnosis is not missed.

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