Differentials
Open-angle glaucoma (primary and secondary)
SIGNS / SYMPTOMS
Clinically indistinguishable from chronic ACG.
INVESTIGATIONS
Gonioscopy shows an open angle.
Other optic neuropathies (e.g., compressive)
SIGNS / SYMPTOMS
Visual field defects are different from those of glaucoma.
INVESTIGATIONS
Intraocular pressure is normal. Gonioscopy shows an open angle. Optic nerve atrophy (whitening of tissue) in contrast to loss of tissue and cupping.
Eye trauma
SIGNS / SYMPTOMS
Acute red eye. Usually no nausea or vomiting. History of recent trauma.
There may be signs of trauma on eye exam and ocular adnexa (eyelid ecchymosis, hyphema, inflammation).
INVESTIGATIONS
Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Keratitis
SIGNS / SYMPTOMS
Acute red eye. Usually no nausea or vomiting.
Conjunctival discharge. Signs of infectious infiltrate in the cornea.
INVESTIGATIONS
Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Conjunctivitis, acute
SIGNS / SYMPTOMS
Acute red eye. Usually no nausea or vomiting.
Conjunctival discharge. Signs of infectious infiltrate in the cornea.
INVESTIGATIONS
Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Corneal ulcer
SIGNS / SYMPTOMS
Acute red eye. Usually no nausea or vomiting.
Recent foreign body, contact lens use, or known poor eye closure (e.g., facial palsy).
INVESTIGATIONS
Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Episcleritis or scleritis
SIGNS / SYMPTOMS
Acute red eye. Usually no nausea or vomiting.
Known systemic disease, such as rheumatoid arthritis.
INVESTIGATIONS
Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Chemical injury
SIGNS / SYMPTOMS
Acute red eye.
History of exposure to chemicals.
INVESTIGATIONS
Intraocular pressure may be elevated, but gonioscopy shows an open angle.
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