A 72-year-old woman presents with a painful red eye, vision of hand movements, and intraocular pressure of 48 mmHg. Slit lamp shows a mature white cataract, a deep anterior chamber with shimmering whitish particles and large floating cells, marked flare, and an open angle on all four quadrants of gonioscopy. The most likely diagnosis is:

• A Phacomorphic glaucoma
• B Lens particle glaucoma
• C Phacolytic glaucoma ✓
• D Glaucomatocyclitic crisis

Explanation

In phacolytic glaucoma a mature or hypermature cataract leaks liquefied lens proteins through an apparently intact capsule. Macrophages engulfing these proteins block the trabecular meshwork, giving a deep chamber, open angle, and an aqueous full of shimmering particles and large ghost cells. Phacomorphic instead shows an intumescent cataract pushing the iris forward with a closed angle and shallow chamber. Lens particle glaucoma follows capsular rupture from trauma or surgery, which is absent here.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.