The Challenge of Managing Bilateral Acute Angle Closure Glaucoma in the Presence of Active SARS-CoV-2 Infection.

Krawitz, Brian D; Sirinek, Portia; Doobin, David; Nanda, Tavish; Ghiassi, Maryam; Horowitz, Jason D; Liebmann, Jeffrey M; De Moraes, C Gustavo

PURPOSE To report a case of bilateral acute angle closure glaucoma associated with hyponatremia in the setting of chlorthalidone use and SARS-CoV-2 infection, and to demonstrate the challenges of managing this patient given her infectious status. METHODS Case report. CASE A 65-year-old woman taking chlorthalidone for hypertension presented to the emergency room with headache, pain, and blurry vision in both eyes and was found to be in bilateral acute angle closure. On laboratory investigation, she was severely hyponatremic and also tested positive for SARS-CoV-2. B-scan ultrasound demonstrated an apparent supraciliary effusion in the right eye. Following stabilization of her intraocular pressures with medical management, she ultimately underwent cataract extraction with iridectomies and goniosynechiolysis in both eyes. CONCLUSIONS We report a rare case of bilateral acute angle closure glaucoma associated with hyponatremia. Chlorthalidone use and perhaps SARS-CoV-2 infection may have contributed to this electrolyte abnormality and unique clinical presentation. Additionally, we discuss the challenges of managing this complex patient with active SARS-CoV-2 infection during the pandemic.