Abstract
Dear Sir We thank Dr Liu for his interest in our paper. However, his remarks, although correct per se, conflict with our case history.
First, we agree that ‘the most common manifestation of intermittent angle-closure glaucoma is not headache but rather visual disturbance’ and that it is more often ‘described by patients as seeing halos around lights’. However, we can assure Dr Liu that a ‘careful history taking’ was performed without observing that symptom. Visual symptoms may vary from one patient to another: this patient had no halos, but flashing light perception in the involved eye.
Second, we agree that fixed, mild mydriatic pupil is the typical sign of highly elevated intraocular pressure. However, pupil block and iris bombe are difficult to detect clinically without anterior segment biomicroscopic examination. In our context the term ‘mydriasis’ has a clinical descriptive meaning, in that it refers to a ‘mid dilated position’, as was observed during the neurological examination, without any physiopathological implications.