Acute Unilateral Intraocular Pressure (IOP) Elevation in the Emergency Room (ER): A Case Report

Aim: To present a clinical case of acute unilateral intraocular pressure (IOP) elevation in the emergency room (ER) that required a complex differential diagnosis, including acute angle closure, trauma, hypertensive uveitis, Posner-Schlossman Syndrome (PSS) or Glaucomatocyclic Crisis and Pigmentary Dispersion Syndrome (PDS).

Presentation of Case: A 15-year-old myopic female presented in the ER with two acute episodes of IOP elevation in the right eye - OD (40-50 mmHg), with mild discomfort and red eye and mild blurred vision in both episodes. Slit lamp evaluation of the OD revealed in the first episode mild pigment in the inferior portion of the endothelium and anterior chamber (AC), white and thin keratic precipitates in the second episode and tyndall in both episodes. Gonioscopy performed in the first episode revealed a thick pigmented trabecular meshwork and ultrasound biomicroscopy (UBM) revealed a mild anterior concavity of the peripheral iris. A laser iridotomy was performed in the first episode and an association of steroids and hypotensive medication was performed in both episodes.

Discussion: After a differential diagnosis analysis, a diagnosis of PDS was made in the first episode and a diagnosis of PSS was made in the second episode.

Conclusion: This clinical case recalls the complexity of some clinical cases, questioning us about the presence of two different pathologies in the same eye, or whether it is the same pathology. Thus, it highlights the need of integration of clinical signs and symptoms to allow a correct differential diagnosis, treatment and follow-up.