Rapidly progressing glaucoma associated with monoclonal gammopathy

A 63 year old woman with surgically controlled primary open-angle glaucoma developed sudden visual field deterioration and subjective visual loss despite stable intraocular pressure in both eyes. An extensive systemic workup was performed which revealed a diagnosis of monoclonal gammopathy of undetermined significance. Further work-up should be considered when the extent of a patient's vision changes is not consistent with a known preexisting disease such as glaucoma.