Delayed diagnosis of subacute angle closure glaucoma in patients presenting with headaches

Abstract

Subacute angle closure glaucoma (SACG) may lead to chronic angle closure glaucoma and irreversible vision loss. Headaches may be the sole presenting symptom. This study characterizes the medical course and symptoms of patients with SACG in whom headache was the major symptom. This retrospective observational study consisted of 30 consecutive patients, suffering from headaches and diagnosed with SACG, collected from the Glaucoma Service at the Ophthalmology Department of Meir Medical Center, Kfar Saba, Israel, a tertiary care referral facility. The primary study outcomes were reasons for referral, number of specialists visited and number of imaging studies performed before diagnosing SACG and headache characteristics. The majority of the patients experienced headaches once or twice a week. Four patients suffered a classic SACG pain involving the eye and frontal or hemicranial area. The mean time from onset of headaches to diagnosis was 2.6 years. The main reason for referral to the glaucoma clinic was consultation (53 %), and SACG was suspected by the referring physicians in two patients. Seventy-three percent of the patients were referred to at least three physicians in various medical specialties prior to referral to the glaucoma clinic. Patients usually do not volunteer history regarding headaches and clinicians often do not associate headaches with SACG in the absence of ocular symptoms. SACG should be included in the differential diagnosis in individuals older than 40 years presenting with late onset of headaches. Such patients should be referred to an ophthalmologist.