"Small eye, big challenge" approach to nanophthalmus in a patient with angle closure glaucoma a case report / Carmelita R. Jocson.

Includes appendices and bibliographical references.

Abstract: This is a case of a 27-year old female who presented with sudden pain of the left eye associated with blurring of vision, eye redness, and shrinking in size of the left eye. Previous consult at another institution was done where patient was administered systematic dose of analgesics and advised cranial computed tomography (CT) scan, the results of which were unremarkable. Patient was lost to follow-up. However, progression of the aforementioned symptoms prompted patient to seek second opinion at our institution. Ophthalmologic examination revealed visual acuity of 20/400 and best-corrected pf 20/40 on the right eye and light perception on the left eye. Intraocular pressure (IOP) on the right eye was 24 mmHg and 60 mmHg on the left eye (which went down to 42 mmHg after 1 dose of Acetazolamide 250mg/tablet). Other ocular findings revealed narrow palpebral fissure of the left eye, a 6mm pupil not reactive to light, a convex iris plane, elevated intraocular pressure, and synechial closure on all angles. Patient was then given pressure-lowering agents and advised to undergo laser Argon laser peripheral iridoplasty and laser peripheral iridotomy for the right eye. Patient was subjected to ancillary examinations such as ultrasound biomicroscopy, A-scan and B-scan ocular ultrasounds, fundus photographs, optical coherence tomography of the macula, and keratometry, were all consistent with the diagnosis of Nanophthalmos. Problems of secondary acute angle glaucoma and macular edema were identified. The patient then underwent trabeculectomy on the left eye. Post-operatively, patient had IOP with 14 mmHg in the right eye and 18 mmHg in the left eye. Best-corrected vision was noted at 20/40 in the right eye (OD) and hand movement in the left eye (OS).

Research - Department of Ophthalmology