BACKGROUND Primary angle closure (PAC) is common in hyperopic eyes, but it is rarely observed in highly myopic eyes. Myopic eyes have a longer axial length and a deeper anterior chamber compared with emmetropic eyes and are considered to be protected from angle closure secondary to pupillary block. PAC can lead to irreversible loss of vision if left untreated. Hence, detection of these atypical cases is important to prevent the permanent sequelae associated with PAC. CASE REPORT We present a case of acute attack of PAC in a patient with high axial myopia. A 53-year-old woman with diabetes presented to the Emergency Department with a 1-week history of pain and redness in the right eye. Ophthalmic examination revealed a high intraocular pressure of 40 mm Hg associated with shallowing of the anterior chamber peripherally in the right eye. The patient’s spherical equivalent was -11.00 diopters in the right eye. Gonioscopy confirmed the presence of a 360° appositional closure of the iridocorneal angle. An acute attack of PAC was diagnosed, and the intraocular pressure was decreased using topical and systemic antiglaucoma medications. Laser peripheral iridotomy was performed to abort the acute attack. CONCLUSIONS Although PAC is unusual in highly myopic eyes, ophthalmologists should maintain a high level of suspicion when such atypical cases are encountered. Myopic refraction does not exclude the possibility of angle closure, and gonioscopy should therefore be performed on all patients at the initial assessment.