Case report describes bilateral secondary angle closure after at-home red light mask use

Overview

A case report describes acute bilateral secondary angle closure with ciliochoroidal effusions in a 43-year-old who had recently begun using an at-home red light therapy mask. After medical treatment and discontinuation of mask use, the effusions resolved and visual acuity returned to 20/20 in both eyes by 2 months. The authors considered a contribution from red light therapy plausible but could not establish causality.

Background

Acute angle closure is an ophthalmic emergency, but angle closure can arise through mechanisms other than pupillary block. Ciliochoroidal effusion and anterior rotation of the ciliary body can shift the lens-iris diaphragm forward and close the angles. The case authors noted prior studies in children receiving repeated low-level red-light therapy for myopia that reported increased choroidal thickness, vessel volume, and perfusion. Whether these reported effects explain the effusions in this case is unknown.

Data Highlights

Key Findings

• The patient presented with acute bilateral vision loss, severe frontal headache, and periocular discomfort; examination showed markedly elevated IOP and closed angles.
• Ultrasound biomicroscopy demonstrated bilateral anterior ciliochoroidal effusions, and the authors considered the presentation most consistent with secondary angle closure from effusions and anterior ciliary body rotation.
• Initial treatment included intravenous acetazolamide, topical IOP-lowering medications, and manual angle decompression. Subsequent treatment included cyclopentolate, prednisolone acetate, hypertonic sodium chloride for more pronounced right corneal edema, and systemic methylprednisolone.
• The patient was instructed to stop using the mask. During close outpatient follow-up, IOP remained low as medications were gradually discontinued, and serial examinations showed resolving effusions and improving vision.
• Recent mask use was the only identified recent lifestyle change; the patient had not used eye protection. She had also received a frontalis botulinum toxin injection 1 week earlier and reported prior similar treatments without complications.
• The authors cited prior pediatric studies of repeated low-level red-light therapy for myopia reporting increased choroidal thickness, vessel volume, and perfusion. They stated that the mechanism of any link to effusions is unknown and that causality could not be established in this single case.

Conclusion

This case links recent at-home red light mask use with bilateral secondary angle closure due to ciliochoroidal effusions, followed by recovery of visual acuity after treatment and cessation of use. The relationship remains uncertain, and the authors reported no previous direct reports linking at-home mask use to choroidal effusions.

Related Resources & Content

1. Labkovich et al., American Journal of Ophthalmology Case Reports, year not provided — A rare acute presentation of simultaneous bilateral angle closure in a patient using a red light therapy mask
2. American Academy of Ophthalmology, Ophthalmology, 2025 — Primary Angle-Closure Disease Preferred Practice Pattern®
3. European Glaucoma Society, 2025 — Terminology and Guidelines for Glaucoma, 6th Edition
4. Herceg and Noecker, Retinal Physician, 2007 — Diagnosis and Treatment of Comorbid Uveitis and Glaucoma
5. Optometric Management — CLINICAL CHALLENGES: Pieces of a Puzzle
6. glaucoma physician — Management of the Primary Angle-closure Suspect
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8. A rare acute presentation of simultaneous bilateral angle closure in a patient using a red light therapy mask
9. Primary Angle-Closure Disease Preferred Practice Pattern®
10. European Glaucoma Society – Terminology and Guidelines for Glaucoma, 6th Edition
11. Primary Angle-Closure Disease Preferred Practice Pattern® - Ophthalmology
12. European Glaucoma Society – Terminology and guidelines for glaucoma, 6th Edition
13. Topiramate-induced bilateral acute angle-closure attack | Spektrum der Augenheilkunde | Springer Nature Link
14. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial - ScienceDirect
15. Fourteen-Year Outcome of Angle-Closure Prevention with Laser Iridotomy in the Zhongshan Angle-Closure Prevention Study - Ophthalmology
16. A rare acute presentation of simultaneous bilateral angle closure in a patient using a red light therapy mask.