Midway through phacoemulsification of a firm cataract, the surgeon notes sudden shallowing of the anterior chamber, a deep-set globe, marked pain in a patient under local anaesthesia, and a tense eye with raised intraocular pressure. The immediate diagnosis is:

• A Irrigating bag emptying leading to hypotonus
• B Posterior capsule rupture with vitreous loss
• C Expulsive suprachoroidal haemorrhage ✓
• D Acute aqueous misdirection (malignant glaucoma)

Explanation

Rupture of a ciliary vessel with bleeding into the suprachoroidal space produces the classic triad of sudden anterior chamber shallowing, rising intraocular pressure, and severe pain out of proportion to the procedure, often with forward displacement of intraocular contents. Posterior capsule rupture does not itself raise pressure or cause pain, an empty irrigation bottle gives a soft eye, and malignant glaucoma is a rare postoperative event, not an abrupt intraoperative crisis in a tense painful globe.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.