An 80-year-old woman presents with a painful red eye, vision hand movements close to face, intraocular pressure 48 mmHg, and a white, shrunken, calcified lens lying free in liquefied cortical matter. Anterior chamber tap shows macrophages engorged with eosinophilic lens protein. The mechanism of her glaucoma is:
- A Forward displacement of the swollen intumescent lens causing pupillary block
- B Lens proteins leaking through an intact capsule and blocking the trabecular meshwork along with protein-laden macrophages ✓
- C Phacoanaphylactic granulomatous inflammation of the trabecular meshwork
- D Dislocation of the lens into the anterior chamber with mechanical angle closure
Correct answer: B. Lens proteins leaking through an intact capsule and blocking the trabecular meshwork along with protein-laden macrophages
Explanation
Phacolytic glaucoma occurs with a hypermature (Morgagnian) cataract: soluble lens proteins escape through microscopic gaps in an intact capsule, are engulfed by macrophages, and together these obstruct the trabecular meshwork. Intumescent lens swelling with pupillary block describes phacomorphic glaucoma, and phacoanaphylaxis is a granulomatous immune reaction requiring prior capsular rupture, neither of which fits this picture.
Reference: Parsons' Diseases of the Eye, 23rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.