Kear Breelan, Gold Claudia R, Bhola Rahul
Providence St. Joseph Hospital Orange, Department of Emergency Medicine, Orange, California.
CHOC Children's Hospital, Department of Pediatric Emergency Medicine, Orange, California.
Clin Pract Cases Emerg Med. 2021 Nov;5(4):443-446. doi: 10.5811/cpcem.2021.7.52671.
Acute angle-closure glaucoma (AACG) is typically considered a disease of adulthood. However, AACG may occasionally be seen in children. The clinical presentation is similar to adults, including headache, vomiting, and eye pain. However, the etiology of angle closure in children is different and most often associated with congenital anterior segment abnormalities. A precipitating factor of AACG in children with previous established, anterior segment abnormalities is eye dilation, which may occur during routine ophthalmological examination with topical mydriasis, or physiologic mydriasis upon entering a dark room.
We describe a 5-year-old child with a history of severe prematurity and retinopathy of prematurity (ROP) presenting with bilateral AACG following a routine outpatient, dilated ophthalmological examination. While angle-closure glaucoma has previously been reported in cases of ROP, a bilateral acute attack of AACG following pupil dilation in regressed ROP has hitherto been unreported.
Given the association of ROP and AACG, it can be expected that as the survival rate of premature infants improves, the incidence of ROP and AACG may also increase. It is therefore prudent for the emergency physician to have AACG on the differential for pediatric patients with headache and eye pain.
急性闭角型青光眼（AACG）通常被认为是一种成人疾病。然而，AACG偶尔也可见于儿童。其临床表现与成人相似，包括头痛、呕吐和眼痛。然而，儿童闭角的病因不同，最常与先天性眼前节异常有关。对于既往有眼前节异常的儿童，AACG的一个诱发因素是散瞳，这可能发生在使用局部散瞳剂进行常规眼科检查期间，或进入暗室时的生理性散瞳。
我们描述了一名5岁儿童，有严重早产和早产儿视网膜病变（ROP）病史，在一次常规门诊散瞳眼科检查后出现双侧AACG。虽然此前在ROP病例中曾报告过闭角型青光眼，但在已消退的ROP患者散瞳后双侧急性发作AACG迄今尚未见报道。
鉴于ROP与AACG之间的关联，可以预期随着早产儿存活率的提高，ROP和AACG的发病率可能也会增加。因此，对于有头痛和眼痛的儿科患者，急诊医生谨慎地将AACG列入鉴别诊断是明智的。
