A 70-year-old man presents with a painful red eye and vision reduced to counting fingers. The cornea is clear, the anterior chamber shows fine white flocculent material with free-floating lens particles, and intraocular pressure is 48 mmHg. The lens is totally opaque and shrunken with a brown nucleus settled inferiorly. The most likely diagnosis is:
- A Phacoantigenic endophthalmitis
- B Lens particle glaucoma
- C Phacolytic glaucoma ✓
- D Glaucomatocyclitic crisis
Correct answer: C. Phacolytic glaucoma
Explanation
In a hypermature (Morgagnian) cataract, liquefied cortical proteins leak through an intact capsule and are engulfed by macrophages, which block the trabecular meshwork. This produces open-angle glaucoma with a deep quiet-looking chamber, floating lens protein, and high pressure. Phacoantigenic endophthalmitis features granulomatous inflammation rather than free protein, and lens particle glaucoma follows capsular rupture with liberated cortical material.
Reference: Khurana, Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.