During routine slit lamp examination, a 55-year-old woman is found to have several tiny grey-white anterior subcapsular lens opacities. She denies any current symptoms. This finding should raise suspicion of:

• A Wilson disease
• B Chronic corticosteroid use
• C Previous blunt trauma to the globe
• D A previous episode of acute congestive angle-closure glaucoma in that eye ✓

Explanation

These opacities are glaukomflecken, patches of necrotic epithelium beneath the anterior lens capsule that form during an episode of markedly raised intraocular pressure such as acute congestive angle closure. They persist permanently and serve as a reliable marker of a past acute attack even years later, when other signs like a fixed mid-dilated pupil may have resolved. Posterior subcapsular opacity would point to steroids, and trauma more often leaves a rosette-shaped cataract.

Reference: Parson's Diseases of the Eye, 23rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.