Six weeks after pars plana vitrectomy with silicone oil tamponade, a patient reports blurred vision. Slit-lamp examination shows a hyperreflective horizontal line of droplets behind the upper corneal endothelium. What is the most likely diagnosis?

• A Recurrent vitreous haemorrhage layering in the anterior chamber
• B Pseudohypopyon from retained perfluorocarbon liquid
• C Emulsified silicone oil forming an inverted hypopyon ✓
• D Steroid-induced keratic precipitates

Explanation

Emulsified silicone oil droplets are lighter than aqueous and float upward, collecting at the superior anterior chamber angle as a whitish level termed an inverted hypopyon. Droplets also appear as glistening fish-egg globules in the pupillary area. Emulsification rises with time and with prior lens extraction, and predisposes to band keratopathy and secondary glaucoma. Perfluorocarbon liquid is heavier than water, so if retained it settles inferiorly, not superiorly.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.