A 60-year-old female presented with painful diminution of vision with nausea for past 2 days. On evaluation, best-corrected visual acuity (BCVA) was 6/9 in the right eye (RE) and finger counting at 2 m in the left eye (LE). IOP as measured by Goldmann Applanation Tonometry was 11 and 48 mmHg in RE and LE, respectively. Microcystic corneal edema with shallow AC was seen in LE. Multiple thin disintegrated iris fibrils were seen floating in the AC from 5 to 7 o'clock in RE and from 4 to 8 o'clock in LE [Figure and ]. Gonioscopy showed 180° and 360° peripheral anterior synechiae (PAS) in RE and LE [], respectively. Laser peripheral iridotomy (PI) was done in both eyes. Lens showed early nuclear sclerosis with a cup-disc ratio of 0.5:1 in RE and 0.6:1 with inferior rim thinning in LE. Corresponding superior arcuate defect was seen on visual fields in LE. She was diagnosed as a case of bilateral iridoschisis presenting as unilateral acute angle closure attack. A combination of two antiglaucoma medications (AGMs) was started in both eyes. On her 6-month evaluation, the patient had an IOP of 12 and 14 mmHg in RE and LE, respectively.
A 23-year-old male presented for routine eye checkup with an IOP of 29 and 26 mm in RE and LE, respectively. On ocular evaluation, iridoschisis was present from 12 to 3 o'clock position in RE and multiple iridoschisis fibers were present at 6, 7, 10, and 11 o'clock in LE. Gonioscopy showed open angles in both eyes. Fundus evaluation showed a cup-disc ratio of 0.6:1 with bipolar thinning in both eyes with corresponding field defects. He was diagnosed as a case of iridoschisis with bilateral juvenile open angle glaucoma. The patient was started on 3 AGMs. On 5th-year follow-up, IOP was 14 mm in both eyes.