The patient walks into to the emergency department (ED) complaining of significant pain in the right eye. It appears red and swollen. The pupils are not equal in size or reactivity – the right pupil remains dilated despite the bright exam room and the flash light. The patient cringes from the bright light, though, and complains the bright lights are hurting his head. He reports that over the last week, both eyes have been aching and he has been seeing halos around lights. The nurse prepares for which test to be performed first?

Question

The patient walks into to the emergency department (ED) complaining of significant pain in the right eye. It appears red and swollen. The pupils are not equal in size or reactivity &ndash; the right pupil remains dilated despite the bright exam room and the flash light. The patient cringes from the bright light, though, and complains the bright lights are hurting his head. He reports that over the last week, both eyes have been aching and he has been seeing halos around lights. The nurse prepares for which test to be performed first?

Accepted Answer

Tonometry. The patient is exhibiting signs of acute narrow angle glaucoma, which is a medical emergency. The intraocular pressure is measured by tonometry; extremely high pressure indicates the need for emergency intervention. The patient was able to walk into the emergency room and reports symptoms from the last week, so neurological involvement (seizures, migraine, brain tumor, elevated intracranial pressure) is unlikely. Therefore, the EEG, MRI, and LP with manometry may not be necessary if tonometry indicates elevated intraocular pressure due to acute narrow angle glaucoma.

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