An 82-year-old man with a mature cataract presents with sudden painful vision loss, IOP of 55 mmHg, and a deep anterior chamber containing floating white particles. Gonioscopy shows an open angle with fluffy material deposited in it. The most likely diagnosis is:

• A Phacolytic glaucoma ✓
• B Phacomorphic glaucoma
• C Lens particle glaucoma
• D Glaucomatocyclitic crisis (Posner-Schlossman syndrome)

Explanation

In phacolytic glaucoma, liquefied cortical proteins from a hypermature cataract leak through an intact capsule and obstruct the trabecular meshwork, giving an open angle, deep chamber, and macrophages laden with lens protein seen as white floating cells. Phacomorphic glaucoma has a swollen lens with a shallow chamber and closed angle. Lens particle glaucoma follows capsular rupture from trauma or surgery. Posner-Schlossman occurs in younger patients without a cataract.

Reference: Robbins and Cotran Pathologic Basis of Disease / Parson's Diseases of the Eye, Latest editions ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.