Incidental Glaucoma in the Un-Affected Eye in Patients Presenting with Ocular Emergencies in a Tertiary Eye Care Hospital in India

Author(s): Gawas Lisika, Roy Avik Kumar, Rao Aparna

Context: This is a retrospective analysis of all patients presenting to the emergency eye care department with either microbial keratitis or trauma and were coincidentally found to have advanced glaucoma in the same or fellow eye.

Aims: Missed diagnosis is a major cause of blindness by glaucoma globally. This study evaluates the clinical profile of incidental glaucoma in the “normal eye” of patients presenting to ocular emergencies.

Settings and design: This was a retrospective review study done in a tertiary eye care hospital in eastern India.

Methods and Material: An electronic medical records audit was done to identify patients presenting to the emergency service of a tertiary eye care hospital between June 2013 to Sept 2020 with the diagnosis of ocular trauma or infection in one eye (affected eye). Patients who were detected to have glaucoma in the same or fellow eye during routine comprehensive evaluation in the emergency clinic and were later referred to the glaucoma department of the institute were included in the study.

Results: Of 5585 patients seen in the emergency services, 41 eyes of 41 patients (diagnosis in the affected eye being microbial keratitis in 29 patients and blunt trauma in 12 patients) were referred for glaucoma in the fellow eye. The fellow eye diagnosis in the glaucoma services included primary open angle glaucoma (n=13), pseudoexfoliative glaucoma (n=9), primary angle closure disease (n=8), glaucoma in pseudophakia (n=4), neovascular glaucoma (n=2), normotension glaucoma (n=2), disc suspect (n=2) and buphthalmos (n=1).

Conclusions: Screening for co-existing blinding diseases like glaucoma in emergency eye clinics is important. Prompt referral and care in a glaucoma clinic may prevent blindness from silent glaucoma in the "better fellow eye" in such cases.

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