Panscleritis masquerading as an attack of primary acute angle closure glaucoma

Abstract

Purpose: To report a female who presented with acute angle closure glaucoma and was found to have panscleritis on further evaluation.

Method: Case report.

Case description: A 50-year-old female was referred to us as a case of primary acute angle closure attack in the right eye and for laser peripheral iridotomy. She had severe pain, redness, a very shallow anterior chamber, and an intraocular pressure of 38 mmHg in the right eye. However, the fellow eye had a deep anterior chamber and the right eye also had severe chemosis, lid edema, scleral tenderness, choroidal folds, and pain during ocular movements which was limited. Ultrasound biomicroscopy showed a ciliochoroidal effusion with anterior rotation of the ciliary body. The ultrasound of the eye revealed an increased thickness of the ocular coats and subtenon fluid. A diagnosis of panscleritis causing secondary angle closure glaucoma was made. She responded well to topical atropine, and topical with systemic steroids.

Conclusions: Secondary angle closure glaucoma due to panscleritis may mimic primary acute angle closure attack in a clinical setting. It is important to differentiate the two as treatment is opposite and may worsen the condition if misdiagnosed.