[Glaucoma attack following Hughes tarsoconjunctival flap: what should be done?].

PURPOSE: The aim of this article is to present a case of acute glaucoma arising in a closed eye 10 days after lower eyelid reconstruction by Hughes tarsoconjunctival flap technique and to discuss clinical strategies to avoid this complication. CASE REPORT: A 61-year-old hyperopic patient presented with a basal cell carcinoma of the lower eyelid. After 2-step tumor resection eyelid reconstruction was performed by Hughes tarsoconjunctival flap technique but 1 week later the patient presented with headache and pain in the contralateral eye. Acute glaucoma was diagnosed and successfully treated (mannitol, aceatazolamide i.v., topical pilocarpine and iridotomy). Some days later the patient came back with relapsed headache and pain in the closed eye. Although the intraocular pressure (IOP) could not be measured acute glaucoma of the right eye as well was suspected and the patient was treated again with mannitol and acetazolamide. As the pain resolved under this therapy the closed eyelid was not opened at this time but the lid reopening was performed at the regular time point (4 weeks postoperatively).
CONCLUSIONS: To the best of our knowledge this is the first published case of an acute glaucoma arising in a topically uncontrolled treatable eye with sutured eyelids. The risk of insufficient treatable acute glaucoma should be included in the patient informed consent when planning eyelid reconstruction by Hughes tarsoconjunctival flap technique. The case supports experimental research efforts to establish techniques of transpalpebral IOP measurement.