What is the presentation of primary closed-angle glaucoma?

• A. Cloudy Cornea With Shallow Anterior Chamber And Halos Around Lights
• B. Diffuse Corneal Edema, Mydriasis, Minimal To No Flare, Episcleral Injection, Blepharospasm +/- Menace, Elevated IOP
• C. Severe Eye Pain With Tearing And Photophobia, Normal IOP
• D. Subconjunctival Hemorrhage With Normal IOP

Answer: (B)

An acute attack of primary angle-closure glaucoma presents with a sudden, very painful red eye and a rapid rise in intraocular pressure from blockage of drainage by the iris. The eye then shows diffuse corneal edema, giving a hazy or cloudy cornea and halos around lights. The pupil becomes mid-dilated (mydriasis) and often poorly reactive, and the anterior chamber tends to be shallow. There is marked episcleral injection and often a painful blepharospasm. The flare in the anterior chamber is typically minimal to absent because the inflammatory changes aren’t the primary issue; the main driver is the abrupt, marked IOP elevation. This combination of hazy cornea, dilated pupil, red eye with pain, and high IOP is the classic presentation of an acute angle-closure attack.