Recently at the EM Core we discussed headache and the red eye.

I had a great case just over a week ago. A patient was triaged with headache and cataract.

On examination he had a very painful right eye, which was causing the headache. He could only see outlines of my fingers…..He had been like this for one week.

Here is a picture of his eye. What do you think?

He had a ciliary flush(although not a huge one.

He had a cloudy cornea.

Visual acuity is decreased.

Pupil was not reactive.

On fluorescein staining, there was nothing to see.

He had ‘compartment syndrome of the eye’ – angle closure glaucoma.

The definitive diagnosis is made by taking pressures. This also differentiates it from keratitis.

Firstly we had trouble calibrating the ‘tono-pen’, then couldn’t measure a pressure with it. Then the penny dropped. I measured the pressure in the good eye and it was 11. The pen wasn’t measuring pressure as it was too high.

Next to treatment – acetazolamide 500mg IV, Timolol eye drops and alphagan eye drops, then transfer for definitive treatment under ophthalmology.