What's the Best Next Step?

Clinical Focus:

• The diagnosis is Acute Angle-Closure Glaucoma (AACG), an ophthalmologic emergency.

Aetiology/Cause:

• Anatomical contact between the anterior lens surface and posterior iris, resulting in pupillary block and trapping of aqueous humor in the posterior chamber.
• Forward bowing of the peripheral iris (iris bombé) occludes the trabecular meshwork at the iridocorneal angle, preventing aqueous outflow.
• Precipitated by pupillary dilation (mydriasis) in anatomically predisposed eyes (e.g., shallow anterior chamber, hyperopia, dense cataracts, or exposure to dark environments/mydriatic medications).

Clinical Features:

• Sudden, excruciating unilateral eye pain and ipsilateral frontal or temporal headache.
• Visual disturbances: rapid loss of visual acuity and characteristic perception of rainbow-colored halos surrounding light sources.
• Autonomic gastrointestinal symptoms: severe nausea, profuse vomiting, and abdominal discomfort.
• Physical findings: marked ciliary injection, 'steamy' or hazy cornea secondary to stromal edema, mid-dilated fixed pupil, and a firm ('rock-hard') globe on digital palpation.

Diagnosis and Investigations: