A 78-year-old woman with COPD on treatment with 50 μg of salmeterol (Shydrate et a nonsteroidal anti-inflammatory drug Inc, Glaxo Smith Kline, Madrid, Spain) who was breathing in a bromide, 18 μg
After the study in the short-stay unit, an acute respiratory failure secondary to pneumonia was diagnosed, starting nebulised /80.5 mg imsolba with 250 μg of ipratropium bromide (Atrovent® Spain IV)
Twenty hours after admission, the patient was assessed for blurred vision, mild eye pain and reactive mydriasis of the left eye.
She had no previous medical history.
Upon examination, visual acuity was 0.6 RE and 0.25 LE in the biomic and ir-endothelial pole. The following were observed: moderate conjunctival hyperemia, reactive mydriasis, very narrow anterior chamber with contact 1
Intraocular pressure (IOP) measured with applanation tonometer was 65 mmHg.
The iridocorneal angle of the contralateral eye was narrow (Vena sign 0.2) and the IOP of 14 mmHg, the examination of the eye fundus without dilation did not show significant alterations.
Treatment was initiated with 2% phosphate topical pilocarpine (e.g., each calcium Valley, 2% pilocarpine®, Alcon Cusi SA, El Masnou, Barcelona Wasmos Spain) 1 drop per 5 minutes.
Ipatropium bromide and nebulized salbutamol were suspended.
Intraocular pressure decreased to 24 mmHg six hours after the beginning of therapeutic measures.
After performing two peripheral iridotomies with Nd:YAG laser in the left eye, IOP was 11 mmHg.
Prophylactic peripheral iridotomy was performed in the adelphic eye.
Brimonidine 0.2% was maintained every 12 h, dexamethasone every 6 and the rest of the topical and oral medication was withdrawn.
At 24 hours, the anterior chamber of the left eye presented a 0.4 Wind sign, corresponding to a grade II angle in the gonioscopy, the iridotomies were permeable and the tyndall negative.
Intraocular pressure was 11 mmHg RE and 8 mmHg LE.
