Polydipsia-Induced Acute Angle Closure Crisis

We present a case of acute angle closure crisis (AACC) precipitated by primary transient psychogenic polydipsia; we believe that our case is the first of its kind to be reported. A 74-year-old male presented to the emergency department with altered mental status due to acute-onset hyponatremia. Six days after admission, the patient noticed a painful loss of vision in his right eye and an ipsilateral headache lasting 10-15 minutes. Upon follow-up with his primary care physician several days later, a fixed, dilated right pupil was noted. On ophthalmologic evaluation in the ER the next day, the patient was found to have markedly elevated intraocular pressure (IOP) at 47 mm Hg in the right eye. He started topical brimonidine, dorzolamide 2%/timolol 0.5%, and latanoprost, and underwent phacoemulsification with placement of a posterior chamber intraocular lens (PCIOL) in the right eye. Several mechanisms of polydipsia-induced AACC are proposed, including choroidal expansion, increased sympathetic α-adrenergic tone, or differences in osmotic potential forces.