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  #1  
Old 04-09-2011
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Eye Pain in the left eye?

54-year-old male presents to his primary care physician complaining of pain in his left eye for the last several hours. He did not sustain any ocular trauma. The left eye is inflamed. He has marked photophobia in his left eye. His intraocular pressure is measured and is markedly elevated in his left eye. Which of the following lesions most likely accounts for his symptoms?

A) Corneal abrasion
B) Inflammation of the iris
C) Inflammation of the uvea
D) Obstruction at the canal of Schlemm
E) Retinal detachment
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  #2  
Old 04-09-2011
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I believe the patient has glaucoma, so I would guess D.

Canal of Schlemm normally drains aqueous humor so any blockage can lead to increased intraocular pressure and thus glaucoma. (Acute angle closure glaucoma I think??)
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  #3  
Old 04-09-2011
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What about - eye is inflamed. I suspect C - uveitis.
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  #4  
Old 04-09-2011
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Quote:
Originally Posted by jahn77 View Post
What about - eye is inflamed. I suspect C - uveitis.
I'm not sure what is meant by "eye is inflamed". Is it the eyelid? Is there increased vascularity in the sclera?

I think the key here is the acute onset of markedly increased intraocular pressure. This seems like glaucoma to me.

I don't think uveitis causes increased intraocular pressure and if it did, I don't know if it would cause such a rapid and significant rise in pressure. Anyone have any insight on this?
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Old 04-09-2011
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Quote:
Originally Posted by Prepping123 View Post
54-year-old male presents to his primary care physician complaining of pain in his left eye for the last several hours. He did not sustain any ocular trauma. The left eye is inflamed. He has marked photophobia in his left eye. His intraocular pressure is measured and is markedly elevated in his left eye. Which of the following lesions most likely accounts for his symptoms?
I thought inflammation may be cause of intraocular pressure increase...
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Old 04-09-2011
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I'll go with B).. sounds like an IOP in angle closed glaucoma..or at least same mechanism.. so apposing iris must be inflamed.
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Old 04-09-2011
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Arrow D) Obstruction at the canal of Schlemm

My ans is D) Obstruction at the canal of Schlemm

open-angle glaucoma - glaucoma caused by blockage of the canal of Schlemm. It produces gradual loss of peripheral vision. Open-angle glaucoma is the most common type of glaucoma.



The aqueous humor is constantly circulating through the anterior chamber. It is produced by a tiny gland, called the ciliary body, situated behind the iris. It flows between the iris and the lens and, after nourishing the cornea and lens, flows out through a very tiny spongy tissue, only one-fiftieth of an inch wide, called the trabecular meshwork, which serves as the drain of the eye.

The trabecular meshwork is situated in the angle where the iris and cornea meet. When this drain becomes clogged, aqueous can not leave the eye as fast as it is produced, causing the fluid to back up. But since the eye is a closed compartment, your `sink´ doesn´t overflow; instead the backed up fluid causes increased pressure to build up within the eye. We call this open (wide) angle glaucoma.

To understand how this increased pressure affects the eye, think of your eye as a balloon. When too much air is blown into the balloon, the pressure builds, causing it to pop. But the eye is too strong to pop. Instead, it gives at the weakest point, which is the site in the sclera at which the optic nerve leaves the eye.

As we mentioned earlier, the optic nerve is the part of the eye which carries visual information to the brain. It is made up of over one million nerve cells, and while each cell is several inches long, it is extremely thin -- about one twenty-thousandth of an inch in diameter. When the pressure in the eye builds, the nerve cells become compressed, causing them to become damaged and, eventually, die.

The death of these cells results in permanent visual loss. Early diagnosis and treatment of glaucoma can help prevent this from happening. Adult glaucoma falls into two categories— open angle glaucoma and closed angle glaucoma



For more reading ...
http://biomed.brown.edu/Courses/BI10.../glaucoma.html
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  #8  
Old 04-09-2011
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Correct Answer Correct Answer is D

Thank you guys for you awesome answers.
Yes, the correct answer is D and everything was explained already.
I'll keep writing questions for this great forum and for the great people in it.
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  #9  
Old 04-10-2011
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Thanks for providing the correct answer. a great way to conclude our discussion
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  #10  
Old 11-17-2012
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Default i hv a confusion plz

obstruction of canal of schlemm produces open angle glaucoma...right..!!!
and open angle glaucoma is painless....!!!!!
and in this scenario THERE IS PAIN...!!!!!!
so it shudnt b D..
plz correct me if i m wrong..!!
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Old 11-18-2012
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As already explained earlier, the answer is definitely d.
Acute angle closure glaucoma is one of the differentials of red eye with decreased vision. Other causes of red eye are - conjunctivitis, anterior uveitis, episcleritis, sub conjunctival hemorrhage etc. Non of them present with increase in IOP as in acute angle closure glaucoma.
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  #12  
Old 11-19-2012
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Quote:
Originally Posted by bilal.sheikh View Post
obstruction of canal of schlemm produces open angle glaucoma...right..!!!
and open angle glaucoma is painless....!!!!!
and in this scenario THERE IS PAIN...!!!!!!
so it shudnt b D..
plz correct me if i m wrong..!!
you are right , i'm with you confused
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Old 11-19-2012
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Default this is classic closed angle glaucoma..B

Quote:
Originally Posted by bendect View Post
you are right , i'm with you confused
@bilal & bendect

i think the guy that posted this question didn't know the answer and was swayed to choose D.

painful & acute presentation rules in closed angle glaucoma.
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  #14  
Old 11-19-2012
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Dnt knw abt that person and i dnt hv the right to yet object on his knwledge..
But abt the question i agree on that..it shud b Closed Angle Glaucoma...
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  #15  
Old 11-19-2012
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Default Answer B

Quote:
Originally Posted by blade View Post
@bilal & bendect

i think the guy that posted this question didn't know the answer and was swayed to choose D.

painful & acute presentation rules in closed angle glaucoma.
I'll go with blade. This is classic case of angle closure glaucoma.
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  #16  
Old 01-23-2013
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The answer is inflammation of the uvea.

Patient has pain in the eye. Eliminating open angle glaucoma. Thus eliminating obstruction of canal of schlemn.

Inflammation of the iris would be painful but not cause an increase in IOP.
Here's a great link to keep the differential easy.
http://www.gpnotebook.co.uk/simplepa...ID=-1435828217


And here's a link to explain uveitis.

http://www.uveitis.net/patient/glaucoma.php
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