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Case Reports
. 2018 Sep-Dec;12(3):142-144.
doi: 10.5005/jp-journals-10028-1259.

Angle-closure Glaucoma in a Myopic Patient Precipitated by Sexual Excitation: A Case Report

Marko Popovic  1 , Matthew B Schlenker  2
Affiliations
Case Reports

Angle-closure Glaucoma in a Myopic Patient Precipitated by Sexual Excitation: A Case Report

Marko Popovic et al. J Curr Glaucoma Pract. 2018 Sep-Dec.

Abstract

Aim: Herein, we report a case of a 55-year-old male who presented with intermittent acute-on-chronic angle-closure glaucoma triggered by sexual excitation.

Background: Sexual excitation is an uncommon cause of pupillary block and angle closure attack.

Case description: A 55-year-old male with a history of myopic laser in situ keratomileusis (LASIK) presented with a volatile intraocular pressure (IOP) and blurred vision over the last seven years. He was particularly symptomatic following sexual excitation. Examination revealed an IOP of 36 mm Hg and best-corrected vision of 20/80 OD, with bilateral closed angles and a double hump sign on gonioscopy. There were advanced glaucomatous changes OD and mild-to-moderate changes OS on optical coherence tomography. Following an exploration of potential options, it was chosen to proceed with OD lens-based surgery, goniosynechialysis and endocyclophotoplasty. During OD recovery, the patient reported an episode of visual blurring OS secondary to sexual excitation, which was consistent with pupillary block and angle closure attack on examination. Initially managed with acetazolamide and laser peripheral iridotomy, he eventually underwent the same surgical procedure OS as for OD. Over 1-year of follow-up, he has achieved a stable IOP and excellent visual acuity bilaterally.

Conclusion and clinical significance: This case highlights the importance of a thorough history, with the understanding that sexual excitation can precipitate angle-closure glaucoma. Gonioscopy must be performed even in the setting of myopia and a deep anterior chamber, and the double hump sign must be assessed. Appropriate education surrounding the risks of sexual activity in angle closure suspects is advised.

How to cite this article: Popovic M, Schlenker MB. Angle-closure Glaucoma in a Myopic Patient Precipitated by Sexual Excitation: A Case Report. J Curr Glaucoma Pract 2018;12(3):142-144.

Keywords: Acute angle-closure glaucoma; Endocyclophotoplasty; Goniosynechialysis; Myopia; Optical coherence tomography.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Figs 1A and B
Figs 1A and B
(A) December 2016, OD–Closed angles visualized on preoperative anterior segment optical coherence tomography; (B) February 2017, OD–Open angles visualized on postoperative week 1 anterior segment optical coherence tomography
Figs 2A and B
Figs 2A and B
(A) December 2016, OD–Closed angles with plateau iris visualized on preoperative ultrasound biomicroscopy; (B) September 2017, OD–Open angles visualized on postoperative ultrasound biomicroscopy
See this image and copyright information in PMC

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