How I see it … conflicting diagnosis

For 10 years, I have thought that one of my eye conditions was narrow or closed-angle glaucoma with episodes of acute angle closure. As a nurse and academic, I have been happy in my knowledge of this disease process and the signs and symptoms of angle-closure glaucoma. The literature and clinic letters support my assumption of this diagnosis. I am happy with identifying signs and symptoms and can sometimes guess my own intraocular pressure from the way I am feeling.

Normal intraocular pressure is 11-22 mmHg. My own experience has been that at 20 mmHg, my eye is irritated, I develop moderate eye pain at around 25 mmHg, I start vomiting. My cornea begins to opacify due to lack of oxygen at 30 mmHg and once the pressure reaches 60 mmHg, the pain is too unbearable to move.

A month ago, I was informed I had normal-tension glaucoma. In other words, damage to the optic nerve and field loss is evident at normal eye pressure. Along with this diagnosis, I started different eye drops.

On review several weeks later, I was informed I had open-angle glaucoma. My understanding of the pathophysiology of glaucoma was that these two mechanisms do not usually co-exist. I questioned this and was informed that this is very unusual.

Firstly I reviewed a video to ensure my understanding of glaucoma was correct.

After searching the literature, there is little information on people who have both open-angle and angle-closure glaucoma. There is a type of glaucoma called mixed glaucoma, but this appears very little after the 1970s in basic literature searches and does not match my presentation.

Over the last week, I have been trying to fit symptoms and knowledge with these new diagnoses. What frustrated me is that these diagnoses do not generally co-exist. This has reminded me of the need we have as humans to categorise things such as these diagnoses to understand them and that medical science is not black and white.

It has also illustrated that this is an uncomfortable place to be outside of the “logical” or “normal” paradigm. As a nurse and academic, I consider myself knowledgeable; however, if I did not have these skills to unpack this or realisation that medical science is fluid, this could be quite intimidating or even “scary”. This has reminded me of what our patients face without knowledge or insight into the healthcare system. It is a timely reminder of the power imbalance that knowledge or lack of knowledge can influence.

2 thoughts on “How I see it … conflicting diagnosis

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  1. Yes it does, as a clinician as well as patient logically this is the case, it is interesting that there is also a conflict between knowing and emotionally being in the situation.

  2. Just about all the patients that I currently work within in my speciality practice fall into this paradigm – symptoms don’t fall within understood presentations or don’t ‘fit the existing medical understanding’ the result is uncertainty, and substantial family distress.

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