Ophthalmology/Eye Institute

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 Department of Ophthalmology Case Studies

 

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Questions:

1. A patient presents with a sudden increase of intraocular pressure to 55 in the left eye. Gonioscopic examination demonstrates a closed angle with trabecular meshwork obstruction. Which of the following is not a likely presenting symptom in this patient:


a. Nausea/vomiting
b. Diplopia
c. Ocular pain
d. Headache
e. Halos around lights


2. What is the mechanism of angle closure in an episode of acute angle closure glaucoma resulting from a pupillary block?
 

a. The lens obstructs aqueous humor flow through the pupil and creates a pressure gradient with subsequent apposition of the peripheral iris with the trabecular meshwork.
b. Decreased drainage by the trabecular meshwork causes increased pressure in the anterior chamber and pushes the iris against the lens.
c. A portion of vitreous humor moves anteriorly and around the lens, blocks the pupil, creates a pressure gradient that subsequently results in the iris moving forward and blocks the angle.
d. Increased aqueous humor drainage through the trabecular meshwork causes a decreased pressure in the anterior chamber, causing a pressure gradient that presses the iris forward and blocks the angle.

 

References:
George A Cioffi, MD, F. Jane Durcan, MD, Christopher A. Girkin, MD, Ronald L. Gross, MD
Peter A. Netland, MD, John R. Samples, MD, Thomas W. Samuelson, MD, Sara S. O’Connell, MD, Keith Barton, MD, Glaucoma BCSC, American Academy of Ophthalmology, 2009.

 

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