Angle-Closure Glaucoma: An Uncommon Cause of a Common Finding

Angle-closure glaucoma, a common entity in Asia, may be primary or secondary. An uncommon cause of secondary angle closure is iridociliary cysts which can gradually close the angle of the anterior chamber and cause high intraocular pressure (IOP) with resultant glaucomatous damage. A 46-year-old male presented with raised intraocular pressure and underwent laser iridotomy in the left eye, but the IOP did not decrease with antiglaucoma drugs. Suspicion of plateau iris or secondary angle closure led us to do an ultrasound biomicroscopy (UBM) of the eyes. Both eyes had multiple variously sized and shaped iridociliary cysts which had caused angle closure. Further investigations by Humphrey visual field analyzer showed advanced glaucomatous damage in the left eye. To prevent further progression and control IOP, which was uncontrolled despite maximum medication, trabeculectomy with mitomycin was done under local anesthesia with resultant control of IOP. The right eye was then subjected to laser iridotomy with control of glaucoma. The patient has been on follow-up for 4 years with no further damage to the optic nerves in both eyes. This is an uncommon presentation of secondary angle closure of both eyes with glaucomatous damage to one eye.