Bilateral Acute Angle Closure Crisis after General Anesthesia for a Breast Surgery

Abstract

Purpose: To report a case of bilateral acute angle closure crisis after general anesthesia for a benign neoplasm of the breastsurgery.Case summary: A 60-year-old female complained of bilateral ocular pain and visual disturbance after recovering from generalanesthesia for wide excision of the left breast operation. Visual acuity was finger count and intraocular pressure (IOP) was measured as 50 mmHg in the right eye and 60 mmHg in the left eye. Slit lamp exam revealed cornea edema, conjunctival injection,and shallow central anterior chamber and narrow peripheral angle in both eyes. Acute angle closure crisis due to anestheticagent was suspected. The symptoms improved after she was prescribed hypotensive eye drops, acetazolamide, and Osmoticdiuretic medication. The next day of the surgery, IOP decreased to 10/10 mmHg and anterior chamber depth was 1.94 mm in theright eye and 1.88 mm in the left eye. Cup to radio was 0.6/0.7 in fundus photography and superotemporal and inferotemporalretinal nerve fiber layer defect was observed in the left eye using optical coherence tomography.Conclusions: It may be necessary to examine the patient for primary angle closure (PAC) and inspect the history of PAC evenbefore non-ocular surgery, especially in patients with risk factors such as old age and female. Careful monitoring is required during the recovery of general anesthesia for ocular symptoms considering the possibility of bilateral acute angle closure crisis.Ann Optom Contact Lens 2020;19(2):48-53Key Words: Bilateral acute angle closure; Ephedrine; General anesthesia; Mastectomy; Primary angle closure