A 28-year-old myopic man reports transient blurred vision with halos after exercise. Examination shows midperipheral spokelike iris transillumination defects, heavy pigmentation of the trabecular meshwork over 360 degrees, and a vertical band of pigment on the corneal endothelium. Cup-to-disc ratio is 0.6 bilaterally. The most likely diagnosis is:
- A Pigmentary glaucoma with Krukenberg spindle ✓
- B Pseudoexfoliation glaucoma
- C Steroid-induced open-angle glaucoma
- D Fuchs heterochromic iridocyclitis
Correct answer: A. Pigmentary glaucoma with Krukenberg spindle
Explanation
The combination of young age, moderate myopia, midperipheral radial transillumination defects, dense homogeneous trabecular pigmentation and the vertical endothelial Krukenberg spindle is classic for pigment dispersion syndrome progressing to pigmentary glaucoma. Pseudoexfoliation affects older patients with flaky deposits rather than uniform pigment. Fuchs heterochromic iridocyclitis shows stellate keratic precipitates and heterochromia without transillumination defects. Reverse pupillary block after exercise is characteristic of pigment dispersion.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.