A 28-year-old myopic man complains of blurred vision and coloured halos after playing basketball. Intraocular pressure is 34 mmHg bilaterally with open angles. Slit lamp shows a vertically oriented brownish deposit on the corneal endothelium, midperipheral radial slit-like iris transillumination defects, and a band of pigment on the trabecular meshwork. The most likely diagnosis is:

• A Herpes simplex trabeculitis
• B Fuchs heterochromic iridocyclitis with glaucoma
• C Pseudoexfoliation glaucoma
• D Pigmentary glaucoma ✓

Explanation

Reverse pupillary block in young myopic males rubs iris pigment off the posterior surface. Liberated pigment forms the vertical Krukenberg spindle on the endothelium, radial midperipheral iris transillumination defects, and heavy homogeneous trabecular pigmentation including the Sampaolesi line. Exercise can release pigment showers with transient pressure spikes. Fuchs syndrome shows unilateral keratic precipitates and heterochromia without transillumination defects, and pseudoexfoliation typically affects older patients with flaky material rather than pigment.

Reference: Shields MB, Textbook of Glaucoma, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.