What emergency presents with sudden severe eye pain and a mid-dilated nonreactive pupil?

What emergency presents with sudden severe eye pain and a mid-dilated nonreactive pupil?

• A. Acute retinal detachment
• B. Acute angle-closure glaucoma
• C. Optic neuritis
• D. Anterior uveitis

Answer: (B)

Recognize an acute angle-closure glaucoma. This condition is an ophthalmic emergency caused by a rapid rise in intraocular pressure from pupillary block, which narrows or closes the anterior chamber angle and prevents drainage of aqueous humor. The mid-dilated pupil that is poorly reactive to light happens because the iris sphincter is ischemic and cannot constrict, while the iris remains dilated. The eye is usually very painful and red, vision is blurred, halos around lights may be seen, and the cornea often becomes cloudy due to edema. This presentation fits because the sudden, severe pain with a mid-dilated, nonreactive pupil is classic for angle-closure glaucoma, unlike retinal detachment (which presents with sudden visual field loss and floaters), optic neuritis (painful eye movements with vision loss and an afferent defect), or anterior uveitis (pain with photophobia and a constricted or irregular pupil with inflammatory cells in the anterior chamber). Management is urgent and focused on lowering the intraocular pressure quickly and relieving the pupillary block, followed by definitive intervention such as laser peripheral iridotomy to prevent recurrence.

Recognize an acute angle-closure glaucoma. This condition is an ophthalmic emergency caused by a rapid rise in intraocular pressure from pupillary block, which narrows or closes the anterior chamber angle and prevents drainage of aqueous humor. The mid-dilated pupil that is poorly reactive to light happens because the iris sphincter is ischemic and cannot constrict, while the iris remains dilated. The eye is usually very painful and red, vision is blurred, halos around lights may be seen, and the cornea often becomes cloudy due to edema.

This presentation fits because the sudden, severe pain with a mid-dilated, nonreactive pupil is classic for angle-closure glaucoma, unlike retinal detachment (which presents with sudden visual field loss and floaters), optic neuritis (painful eye movements with vision loss and an afferent defect), or anterior uveitis (pain with photophobia and a constricted or irregular pupil with inflammatory cells in the anterior chamber). Management is urgent and focused on lowering the intraocular pressure quickly and relieving the pupillary block, followed by definitive intervention such as laser peripheral iridotomy to prevent recurrence.