A 72-year-old man presents with pain and blurred vision in the left eye. The intraocular pressure is 48 mmHg. Slit lamp shows a white hypermature cataract with a shallow anterior chamber containing small white flocculent particles, and gonioscopy shows an open angle. The most likely diagnosis is:
- A Phacomorphic glaucoma
- B Phacolytic glaucoma ✓
- C Lens particle glaucoma
- D Glaucomatocyclitic crisis
Correct answer: B. Phacolytic glaucoma
Explanation
Phacolytic glaucoma occurs with a hypermature (Morgagnian) cataract whose capsule becomes permeable, allowing liquefied lens proteins to escape. Macrophages engorged with lens protein and the proteins themselves obstruct an otherwise open trabecular meshwork, giving an open angle with white pseudohypopyon-like particles. Phacomorphic glaucoma is angle closure caused by an intumescent cataract pushing the iris forward, so the closed angle kills option A.
Reference: Khurana, Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.