Vogt-Koyanagi-Harada syndrome presenting as bilateral simultaneous acute angle closure

Presentation of bilateral simultaneous angle closure in a patient must alert one to look beyond the common “knee-jerk” diagnosis of acute primary angle closure (APAC). We describe a case with bilateral simultaneous acute angle closure with signs of anterior chamber inflammation with intraocular pressure of 60 mmHg. Based on the clinical details and ultrasonic findings of peripapillary choroidal thickening and supraciliary fluid, a diagnosis of Vogt-Koyanagi-Harada (VKH) disease was made. Our case highlights that every angle closure is not a primary angle closure requiring laser peripheral iridotomy. Detailed clinical examination with appropriate investigations could prevent misdiagnosis of APAC in VKH.