PUBLICATION EXCLUSIVE: Man presents with sudden bilateral angle closure and myopic shift

A 40-year-old male airline pilot with no significant medical or ocular history presented as an urgent walk-in to the Tufts New England Eye Center Comprehensive Ophthalmology Clinic with 18 hours of sudden onset bilateral blurry vision. One day before presentation, he had been flying a commercial airplane from Hong Kong to Los Angeles when his vision became acutely blurry, and he could no longer read the control panels on the airplane. His vision became so hazy that his co-pilot had to take over for the rest of the flight. He had no other ocular symptoms at that time, and his systemic review of symptoms was negative other than an upper respiratory infection 3 weeks prior for which he had taken 5 days of azithromycin.When he landed in Los Angeles, he went to a local ophthalmologist who noted that his vision had decreased to 20/80 but corrected to 20/20 in both eyes with a refractive error of –5 D. His prior correction was –3 D in each eye. IOP was 28 mm Hg in the right eye and 32 mm Hg in the left eye, and his anterior chambers were very shallow bilaterally. The ophthalmologist recommended urgent bilateral laser peripheral iridotomies (LPIs), but the patient deferred, preferring to be treated in Boston where his family was based. He was started on acetazolamide, dorzolamide, brimonidine and pilocarpine with an adequate improvement in IOP, and the patient then boarded the next flight to Boston.