An 72-year-old man presents with a red, painful eye and vision reduced to counting fingers. He has a mature hypermature cataract. Intraocular pressure is 48 mmHg. Gonioscopy shows an open angle. Aqueous tap reveals lens proteins and macrophages engorged with lens material. The most likely diagnosis is:

• A Phacomorphic glaucoma
• B Phacolytic glaucoma ✓
• C Lens particle glaucoma
• D Phacoanaphylactic glaucoma

Explanation

Phacolytic glaucoma occurs when a mature or hypermature cataract leaks soluble lens protein through an intact capsule into the anterior chamber. The protein obstructs the trabecular meshwork directly and attracts macrophages laden with lens material, giving the classic open-angle picture with milky aqueous and floating white particles. Phacomorphic glaucoma instead shows an intumescent lens closing a shallow angle. Lens particle glaucoma follows capsular rupture, and phacoanaphylaxis is granulomatous inflammation.

Reference: Kanski's Clinical Ophthalmology, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.