This document presents the case of a 40-year-old male carpenter who presented with decreased vision in his left eye over the past 4 months. On examination, he was found to have chronic primary angle closure glaucoma in his left eye, with a shallow anterior chamber, mid-dilated pupil, posterior synechiae, and high intraocular pressure of 36 mmHg. He had been prescribed topical eye drops previously but his vision did not improve. The right eye was normal. He was advised to continue his eye drop medications and take acetazolamide tablets for a week, with plans for trabeculectomy surgery on the left eye.

1. CASE PRESENTATION
CHRONIC PACG
BY:- DR. SUDHANSHU SHEKHAR
1ST YR OPHTHAL PGT
MGM MEDICAL COLLEGE, KISHANGANJ

2. • NAME= Muzammil
• Age= 40yr male
• Address= Kishanganj
• Occupation= carpenter
• Came to our eye OPD on 22/01/2021
Chief complaint:
Left eye Diminution of vision since 4 months.

3. HISTORY OF PRESENT ILLNESS:-
• h/o Decrease vision of left eye 4month back associated with redness for which he
attended a local hospital at kishanganj and was prescribed with topical eye drops and
tablets. But he came to our hospital for better management.
• No h/o redness, watering of eye
• No h/o pain , nausea, vomiting
• No h/o headache

4. PAST OCULAR HISTORY:
• history of using spectacles.
RE: +1.00D sph LE: +1.00D sph
• h/o ocular trauma left eye with fist 4 month back
• No h/o ocular surgery
• No h/o DM/HTN/Asthma/Allergy or any other systemic illness
Ocular medications:
• E/d IOTIM Plus(timolol + pilocarpine) – twice daily
• Tab GLOEYE (bilberry extract + pine bark extract) – OD 20days

5. FAMILY HISTORY:-
• No significant family history.
• No h/o glaucoma case in family members.

6. GENERAL PHYSICAL EXAMINATION:-
• No h/o pallor
• No h/o icterus
• No h/o cyanosis
• No h/o clubbing
• No h/o lymphadenopathy
 vitals:- temp= 98.8*F , RR= 20
BP= 130/80mmhg, pulse= 70bpm

7. OCULAR EXAMINATION:-
Right eye Left eye
Visual acuity aided 6/6p 6/18p , not improved with pin
hole
Lids normal normal
conjunctiva clear Clear
cornea clear Clear
Ant chamber Normal depth shallow
Iris Normal pattern PPM , Post synechiae @4-5
o’clock
Pupil R/R/R Mid dilated pupil, brisk, fibrin
membrane with pigments
lens clear Iris pigments on lens
Extra-ocular movement full full
IOP on AT(1st visit) 22/01/2021 16 26
IOP on AT(2nd visit) 05/02/2021 16 36

8. LEFT EYE SLIT LAMP

9. FUNDOSCOPY
Right eye
Media clear,
CDR= 0.3
v/s= normal
FR= dull
Tessellated fundus
Left eye
Media clear,
CDR= 0.8-0.9 , pale disc,
laminar dot sign+nt,
bayoneting sign +nt
v/s= nasal shifting of vessels,
FR= dull
Tessellated fundus

10. INVESTIGATION:-
• GONIOSCOPY:-
SHAFFER grading
R/E grade 2
L/E grade 0 (360 degree PAS)

11. PROVISIONAL DIAGNOSIS
• LE chronic primary angle closure glaucoma with PPM

12. TREATMENT GIVEN:-
1st visit on 22nd jan 2021:-
• Advice: E/D pilocarpine(2%) 1 drop 3 times per day
E/D timolol(0.5%) 1 drop 2 times per day
• But patient didn’t took pilocarpine e/d.
2nd visit on 5th feb 2021:-
• Advice: Continue same previously prescribed eye drops.
Tab Diamox 250mg 1 tab TID for 7days.
Banana as potassium supplements advised
Plan for trabeculectomy LE.
Left eye