Early Recognition and Timely Cataract Surgery Are Critical to Prevent Irreversible Optic Nerve Damage in Acute Primary Angle Closure

Abstract

Acute primary angle closure represents an ophthalmic emergency, and this forms the basis of the introduction of the case, as the condition can cause a sudden and severe rise in intraocular pressure leading to rapid and irreversible optic nerve damage when diagnosis and treatment are delayed. The objective of this report is to describe the clinical presentation, diagnostic evaluation, and management of acute primary angle closure occurring together with an immature senile cataract in a patient treated at Mata Masyarakat Hospital, Surabaya, Indonesia. The methods applied in this case involve a descriptive case report approach that outlines the patient’s clinical course, examination findings, and therapeutic interventions. The results of the clinical evaluation showed that the patient experienced progressive visual decline, ocular pain, redness, headache, and halos in the left eye. Examination revealed markedly elevated intraocular pressure of 49.5 mmHg, corneal edema, a shallow anterior chamber, a mid‑dilated pupil, glaukomflecken, and thinning of the retinal nerve fiber layer with neuroretinal rim loss. The diagnosis of acute primary angle closure with an immature senile cataract was established, while the fellow eye was categorized as a primary angle closure suspect. After surgical management, intraocular pressure decreased and visual acuity improved partially, although structural optic nerve damage remained irreversible.

In conclusion, this case illustrates the multifactorial nature of angle‑closure disease and emphasizes the importance of early recognition, multimodal assessment, and timely surgical intervention to prevent permanent glaucomatous optic neuropathy.

Keywords: angle closure glaucoma; intraocular pressure; cataract; optic nerve diseases; phacoemulsification