Bilateral Acute Angle Closure Glaucoma After Prone Position Ventilation for COVID-19 Pneumonia

Nerlikar, Roopali R.; Palsule, Aratee C.; Vadke, Shantanu

We report a case of bilateral acute angle closure glaucoma developing after prone position ventilation for severe COVID-19 pneumonia. A 53-year-old diabetic and hypertensive male developed blurred vision and ocular discomfort in both eyes after prone position ventilation for severe COVID-19 pneumonia. At initial examination he was noted to have diffuse corneal edema with shallow anterior chambers and mid dilated non reacting pupils. His intraocular pressure was 48 and 54 mm Hg in right and left eye, respectively. Following intravenous mannitol (20%) infusion, oral acetazolamide 250 mg 3 times daily, along with topical therapy with combination Brimonidine and Brinzolamide eye drops and Fluoromethalone eye drops his corneal edema resolved and subsequent to laser iridotomy his intraocular pressures lowered significantly and could be maintained below 16 mm Hg in both eyes with topical therapy alone. With prone position ventilation being a commonly used adjuvant treatment for acute respiratory distress syndrome associated with COVID-19 pneumonia, acute angle closure may be precipitated in these patients if they have pre-existing narrow angles. Awareness of the possibility and its recognition may allow prompt ophthalmic referral, early treatment and minimize visual consequences.