Acute Angle Closure Following Uncomplicated Pterygium Excision

Introduction: Pterygium excision is a commonly preformed procedure, with known and established complications. Acute angle closure is not a reported complication following routine pterygium extraction. We report a patient who had routine pterygium excision, and subsequently developed an angle closure attack. Case Description: A 56-year-old female presented to the ophthalmology clinic with a pterygium and an asymmetric cataract, greater in the right eye. Prior to A-scan and keratometry for cataract surgery, the pterygium was removed, using lidocaine with epinephrine for anesthesia and hemostasis. The pupil dilation subsequent to the epinephrine precipitated an angle closure episode the following day, and was treated successfully with laser peripheral iridotomy. Discussion/Conclusion: This case highlights the importance of gonioscopy, anterior chamber assessment, and lenticular examination prior to any ocular procedure or use of medications that can affect pupil and angle anatomy. We also advise judicious use of epinephrine with anesthetic in narrow angled eyes.