The Challenge of Managing Bilateral Acute Angle-closure Glaucoma in the Presence of Active SARS-CoV-2 Infection

Krawitz, Brian; Sirinek, Portia; Doobin, David J.; Nanda, Tavish; Ghiassi, Maryam; Horowitz, Jason; Liebmann, Jeffrey M.; Moraes, Carlos Gustavo De

doi:10.1097/ijg.0000000000001763

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…In addition to haemodialysis, drugs such as chlorthalidone can cause hyponatremia and increase intraocular pressure. 3 The incidence of acute angle-closure glaucoma attacks after COVID-19 infection is unknown; however, there are case reports in the literature that show the development of angle-closure glaucoma in patients who have been infected with COVID-19. Roopali et al detected bilateral angle closure in a 56-year-old diabetic and hypertensive patient who had stayed in a prone position because of COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

“…The patient's serum sodium level was 118 mMol/L and a polymerase chain reaction (PCR) test for COVID-19, taken from a nasopharyngeal swap, was positive. 3…”

Section: Discussionmentioning

confidence: 99%

“…1 Changes in serum electrolyte levels also alter IOP, and hyponatremia, in particular, can cause an increase in IOP and angle closure by creating an osmotic pressure difference between the humour aqueous and the blood serum. 3…”

Section: Introductionmentioning

confidence: 99%

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Acute angle-closure glaucoma concurrent with COVID 19 infection; case report

Özmen

Aksoy

Çakır

et al. 2022

European Journal of Ophthalmology

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Introduction To report three cases that developed acute angle-closure glaucoma on the background of hyponatremia due to COVID 19 infection. Methods Data of patients with positive PCR result for COVID 19 infection and concurrent findings of acute angle-closure glaucoma were analysed retrospectively. Results The common characteristic of all cases was positive PCR test for COVID 19 infection taken from the nasopharyngeal swab 4 or 5 days ago. Their serum sodium levels were lower than 135 mmol / L. At the initial ophthalmic examination, all cases had diffuse corneal edema with shallow anterior chambers and mid-dilated non-reacting pupils.The choroid was evaluated as normal by ocular ultrasonography. Intraocular pressures (IOP) of the first, second, and third cases were 35 mmHg, 44 mmHg, and 40 mm Hg, respectively. 5–10 cc/kg mannitol was given to all patients intravenously within 30 min. Simultaneously, they began to use oral acetazolamide, topical pilocarpine, beta-blocker, and prednisolone acetate drops.After stabilization of IOP, Neodymium-doped yttrium aluminum garnet;(ND: YAG) Laser iridotomy was performed on all patients. No additional fluid therapy was given to the patients other than mannitol, and it was determined that the blood sodium level remained at normal levels after diuresis. Discussion Hyponatremia is the most common electrolyte disorder in COVID 19 infection. Hyponatremia may cause an angle-closure attack in patients with shallow anterior chamber angles.Therefore, one should be aware of the possibility of angle-closure glaucoma in patients who develop hyponatremia due to COVID 19 disease. Suspected patients should be referred to the ophthalmology department.

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Section: Discussionmentioning

confidence: 99%

“…The patient's serum sodium level was 118 mMol/L and a polymerase chain reaction (PCR) test for COVID-19, taken from a nasopharyngeal swap, was positive. 3…”

Section: Discussionmentioning

confidence: 99%

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Acute angle-closure glaucoma concurrent with COVID 19 infection; case report

Özmen

Aksoy

Çakır

et al. 2022

European Journal of Ophthalmology

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“…In the literature, there is a case report of increased intraocular pressure and angle-closure glaucoma due to change in electrolyte level after COVID-19 infection. Krawitz et al [15] detected angle-closure glaucoma after hyponatremia due to chlortalidone use in a 65 years old patient who had positive nasopharygeal swab test for COVID-19. Hyponatremia is the most common electrolyte disorder in COVID-19 disease and has been associated with high mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, fluid transition to humor aqueous occurs from serum. Fluid passage into humor aqueous causes increase in intraocular pressure [15]. Depending on the change in intraocular pressure, RNFL and GS-IPL may also become thinner.…”

Section: Discussionmentioning

confidence: 99%

The effect of COVID-19 infection on retinal nerve fiber layer and ganglion cell complex layer thicknesses

Özmen¹,

Çakır²,

Okan³

et al. 2021

j-ebr

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To evaluate the possible effects of SARS-CoV-2 infection on retinal nerve fiber layer (RNFL) and ganglion cell complex layer (GC-IPL) thicknesses. Method: Patients who had been infected by SARS-CoV-2 and hospitalized because of severe pneumonia were found out from the database of COVID-19 pandemic hospital and formed the patient group. The control group was composed of non-COVID-19 age-matched subjects. The mean and fragmented RNFL and GC-IPL thicknesses were measured by optical coherence tomography (OCT), and compared between two groups, statistically. Results: Patient group 34 eyes of 34 subjects (18 male, 16 female) and 31 eyes of 31 subjects (14 male, 17 female) in the control group were enrolled. The mean age and gender were not statistically different between groups (p:0.56, 0,57, respectively).A statistically significant difference was not found between groups in terms of mean, superior, inferior, temporal, nasal RNFL thicknesses and mean superior, inferior, temporal, and nasal GC-IPL thicknesses. Conclusion:The mean and fragmented RNFL and GC-IPL thicknesses measured by OCT were not statistically different in patients who had moderate disease course and recovered from COVID-19 infection.

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Chlortalidone

2021

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Bilateral acute angle closure glaucoma and hyponatraemia: case reportA 65-year-old woman developed bilateral acute angle closure glaucoma and hyponatraemia during treatment with chlortalidone for hypertension.The woman presented to the emergency department with three days of sudden onset bilateral eye pain and blurry vision that occurred upon waking, associated with headache and nausea. Her medical history was significant for hypertension and hyperlipidaemia and she had been receiving chlortalidone [chlorthalidone; route and dosage not stated], atenolol and lisinopril. She did not have any respiratory symptoms. However, her family members had been experiencing fever, cough, fatigue and myalgias during the last 2 weeks. She was hospitalised. On initial examination, her best corrected visual acuity (BCVA) was 20/300 in the right eye and 20/200 in the left eye. Her both pupils were mid-dilated and nonreactive. Intraocular pressure (IOP) was 50mm Hg in both eyes. Slit-lamp examination showed microcystic corneal oedema in both eyes. Also, both anterior chambers were noted to be shallow centrally with a 1+ cellular reaction and a convex iris configuration. Trace nuclear sclerotic cataracts were observed. Gonioscopy of both eyes revealed a closed iridocorneal angle in all quadrants. An examination of the posterior segment revealed clear vitreous bilaterally, healthy optic nerves with a 0.2 vertical cup-to-disc ratio, flat maculas and normal peripheral retinas without visible choroidal effusions.The woman was started on acetazolamide, pilocarpine and unspecified topical aqueous suppressants for presumed bilateral acute primary angle closure with pupillary block. Her sodium level was noted to be 118 mmol/L, consistent with severe hyponatraemia. Additionally, she was diagnosed with COVID-19 infection. Immediately, she was escorted back to the emergency department for electrolyte management. As per the nephrology team, her low sodium was due to hypovolaemia from emesis and decreased oral intake in the setting of chlortalidone use. Her bilateral acute angle closure glaucoma was also attributed to chlortalidone [duration of treatment to reactions onset not stated]. Her IOP measured after 1h was 27 and 24 in the right and left eyes, respectively. However, her pupillary findings were unchanged. Pressures were maintained in both eyes with topical therapy and an improvement was noted in her symptoms. Chlortalidone was discontinued. She was treated with normal saline [sodium chloride] leading to improvement in her serum sodium level. Early in the following week, she was brought to the eye clinic, where she reported eye pain in the right eye worse than left. Also, she refused her eye drops and her IOP was noted to be elevated in both eyes. Iridotomies were performed; however, it was unsuccessful due to a limited view through corneal oedema. The pressures were able to be reduced acutely with medical therapy alone. Iridotomies were not re-attempted considering active COVID-19 infection. Over the next several days, the pressures were ...

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The Challenge of Managing Bilateral Acute Angle-closure Glaucoma in the Presence of Active SARS-CoV-2 Infection

Cited by 12 publications

References 21 publications

Acute angle-closure glaucoma concurrent with COVID 19 infection; case report

Acute angle-closure glaucoma concurrent with COVID 19 infection; case report

The effect of COVID-19 infection on retinal nerve fiber layer and ganglion cell complex layer thicknesses

Chlortalidone

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