The authors describe a case report of a 60-year-old woman found to have advanced angle closure glaucoma in her right eye and appositional closure of half of the left eye and no glaucoma. The patient had previously undergone two trabeculectomies to her right eye which showed advanced glaucomatous damage on visual fields; the left eye had no visual field defect and normal intraocular pressure (IOP). Gonioscopy of the right eye showed peripheral anterior synechiae for over 270 degrees completely covering the trabecular meshwork. Indentation of the left eye showed significant relative pupillary block in all quadrants with the nasal angle completely closed by apposition. The nasal trabecular meshwork was lightly pigmented and the temporal angle was open. Ultrasound biomicroscopy (UBM) was performed and showed a ciliary body tumour preventing angle closure. This case report highlights the need for careful gonioscopy.