Angle Closure Glaucoma Precipitated by Third Nerve Palsy

A 67 year old white male presented with a unilateral complete third nerve palsy following an adenoma-induced pituitary apoplexy. Ophthalmic examination prior to trans-sphenoidal removal of the tumor revealed very shallow anterior chambers and a phakic refractive error of +9.00 D OU but no evidence of glaucoma. Post operatively, on resolution of the third nerve palsy, the patient developed an angle closure glaucoma in the affected eye, presumably as his pupil regained the mid-dilated state. Laser iridotomy has been successful in preventing attacks in the fellow eye and has resulted in a gonioscopically observable opening of the angle. However, iridotomy failed to open the angle in the affected eye and trabeculectomy was eventually necessary to contol the intraocular pressure.