Panscleritis masquerading as an attack of primary acute angle closure glaucoma.

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.