A 70-year-old man presents with a painful red eye, vision of hand movements, a white mature cataract, a deep anterior chamber containing floating shimmering particles, and IOP of 46 mmHg. Gonioscopy shows an open angle. The most likely diagnosis is:

• A Phacomorphic glaucoma
• B Lens particle glaucoma
• C Phacolytic glaucoma ✓
• D Acute primary angle-closure glaucoma

Explanation

In a hypermature Morgagnian cataract, liquefied cortical lens protein leaks through an intact capsule, is engulfed by macrophages, and blocks the trabecular meshwork. The hallmark is a deep anterior chamber with floating white particles and an open angle despite very high pressure. Phacomorphic glaucoma shows a swollen lens with a shallow chamber and closed angle. 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.