Case report

A 26-year-old woman presented to the emergency department with progressive bilateral loss of vision over 2 h, followed by mild unilateral headache, nausea and eye discomfort. Her only past ocular history was of low myopia (−1.25 DS both eyes). She had a history of mixed connective tissue disease and migraine, for which she had taken topiramate 25 mg daily for 2 weeks before presentation.

On examination, her visual acuity was down to counting fingers in both eyes. The pupils were equally reactive to light with no relative afferent pupillary defect. Funduscopy was normal. Slit lamp examination found very shallow anterior chambers (figure 1) and gonioscopy showed bilaterally occluded iridocorneal angles. Intraocular pressures were elevated at 30 mm Hg in both eyes.

Anterior segment optical coherence tomography showed forward displacement of the iris with iridocorneal apposition …