A 55-year-old woman presented to the emergency department in January, 2014, with 1 day of headache, vomiting, and painful vision loss. On examination she was systemically well and was referred to ophthalmic casualty. Best corrected visual acuity was counting fingers at 3 m, and intraocular pressure (IOP) was 40 mm Hg bilaterally. Examination of both eyes showed corneal haze, mid-dilated pupils, and closed angles on gonioscopy (appendix). The fundus was normal, with no cells in the anterior chamber or vitreous. Since primary angle closure is rarely bilateral, we sought a secondary cause. Ultrasound bimicroscopy showed supracilliary fluid (appendix), but we could not elicit history of any possible cause, such as psychotropic drugs. We started topical steroids 2-hourly, oral acetazolamide 250 mg four times a day, atropine 1% drops three times a day, topical brimonidine 0 ? 2% and timolol 0.5% twice daily, and systemic steroids once daily. The next day her best corrected visual acuity had improved to 6/12, and IOP came down to 22 mm Hg in both eyes. We stopped oral acetazolamide.
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机译：一名55岁的妇女于2014年1月到急诊室就诊，出现了1天的头痛，呕吐和痛苦的视力丧失。经检查，她的身体状况良好，被转诊至眼科伤亡。最佳矫正视力是在3 m时对手指计数，双眼眼压（IOP）为40 mm Hg。两只眼睛的检查均显示角膜混浊，瞳孔中部散大，并且在角膜镜检查中呈闭合角度（附录）。眼底正常，前房或玻璃体中无细胞。由于主角闭合很少是双侧的，因此我们寻求第二位原因。超声双镜检查显示出视上清液（附录），但我们无法得出任何可能原因的病史，例如精神药物。我们开始局部使用类固醇2小时一次，口服乙酰唑胺250毫克，每天4次，阿托品1％滴剂，每天3次，局部溴莫尼定0？每天两次，每次2％，噻吗洛尔0.5％，全身类固醇，每天一次。第二天，她的最佳矫正视力提高到6/12，并且双眼的IOP降至22毫米汞柱。我们停止口服乙酰唑胺。
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