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Bilateral Angle Closure Glaucoma in HIV Infection

A 56-year-old HIV positive man presented to the ophthalmology department with a sudden onset of bilateral painful red eyes. He had complained of blurred vision 48 h prior to the onset of pain. There was no significant ocular history. The patient had been diagnosed as HIV positive 8 years previously and had a C04 count of 120/JlL at presentation. On examination visual acuity was reduced to hand movement perception bilaterally. The conjunctival vessels were diffusely hyperaemic and diffuse stromal and epithelial microcystic corneal oedema was present. The pupils were mid dilated and non-reactive to light. The anterior chambers were markedly shallow peripherally. The irides had no bombe and the intraocular pressures by applanation tonometry were 45 and 50 mmHg in the right and left eyes respectively. Bilateral angle closure glaucoma was diagnosed and ultrasound scanning later confirmed bilateral ciliochoroidal effusions (Figure 1). Cycloplegic therapy was instituted in addition to topical betamethasone phosphate 0.1% at 2-h intervals, levobunolol 0.5% twice a day and oral acetazolamide 250 mg four times daily. The patient showed an excellent response to treatment with deepening of his anterior chambers and reduction of his intraocular pressures to 9 and 11 mmHg within 36 h. Ten days following treatment the corneal oedema had largely resolved and his visual acuities were 6/9 bilaterally. Bilateral glaukomflecken were noted at this time. A similar episode occurred 4 months later which responded equally well to treatment. The patient died 10 months after his initial attack.