Which of the following characterizes acute angle-closure glaucoma?

• A. Itchy eyes with mild conjunctival injection.
• B. Floaters and photophobia without systemic symptoms.
• C. Gradual vision loss with no pain.
• D. Sudden vision loss, severe pain, red eye, tearing, halos, high intraocular pressure, headache, nausea, vomiting.

Answer: (D)

Acute angle-closure glaucoma is all about a rapid, dangerous rise in eye pressure that produces a sudden, painful red eye with systemic symptoms. The hallmark is the abrupt onset of very painful vision loss, a red eye, tearing, halos around lights, and often headache, nausea, or vomiting. The pupil is often mid-dilated and the eye can feel firm to palpation due to a sharp surge in intraocular pressure. This combination signals an emergency because the high pressure can quickly damage the optic nerve if not treated right away.

The other patterns don’t fit this emergency picture. Itchy eyes with mild conjunctival injection point to allergic conjunctivitis, which is typically itchy and lacks the severe eye pain and high pressure. Floaters and photophobia without systemic symptoms suggest posterior segment or corneal/uveal problems but not the sudden, alarming IOP surge typical of an acute attack. Gradual vision loss without pain fits chronic processes like cataracts or chronic open-angle glaucoma, which evolve slowly and are not associated with an abrupt, painful red eye and associated systemic symptoms.

Because this condition can lead to irreversible vision loss if not addressed promptly, recognizing the combination of sudden eye pain, redness, tearing, halos, high pressure, and associated malaise or nausea is critical for urgent care and referral.