Acute angle-closure glaucoma concurrent with COVID 19 infection; case report

Area of Science:

• Ophthalmology
• Infectious Diseases
• Endocrinology

Background:

• COVID-19 infection is frequently associated with electrolyte disturbances, particularly hyponatremia.
• Hyponatremia, a low serum sodium level, is the most common electrolyte disorder observed in COVID-19 patients.
• This case series investigates the link between COVID-19-induced hyponatremia and acute angle-closure glaucoma.

Observation:

• Three patients with confirmed COVID-19 infection presented with acute angle-closure glaucoma.
• All patients exhibited hyponatremia (serum sodium <135 mmol/L) and ophthalmic signs including corneal edema, shallow anterior chambers, and mid-dilated pupils.
• Ocular ultrasonography revealed normal choroidal findings, while intraocular pressures ranged from 35-44 mmHg.

Findings:

• Treatment involved intravenous mannitol, acetazolamide, topical medications, and Nd:YAG laser iridotomy.
• Patients' serum sodium levels normalized post-treatment without additional fluid therapy.
• The rapid management successfully stabilized intraocular pressure and resolved glaucoma symptoms.

Implications:

• COVID-19-associated hyponatremia can precipitate angle-closure glaucoma, especially in individuals with pre-existing shallow anterior chamber angles.
• Ophthalmologists and infectious disease specialists should be vigilant for angle-closure glaucoma in COVID-19 patients with hyponatremia.
• Early recognition and referral to ophthalmology are critical for managing this sight-threatening condition.