Question of the Week

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A 70-year-old female reports blurry vision and intermittent glare in her left eye (OS) over the past six months. Her visual acuity is 20/25 OD and 20/80 OS. Intraocular pressure is measured at 18 mmHg OD and 50 mmHg OS. On slit-lamp examination, a patchy, flaky material is noted along the pupillary margin OS, with a “bullseye” pattern visible on the anterior lens capsule. Gonioscopy reveals moderate pigmentation in the angle with no signs of angle closure. Fundoscopic examination shows advanced optic nerve cupping in the left eye. Which of the following findings would most support a diagnosis of pseudoexfoliation glaucoma in this patient?

A. A “bullseye” pattern on the anterior lens capsule

B. Increased intraocular pressure with a closed angle on gonioscopy

C. Dense corneal edema and severe pain

D. History of recurrent iritis in the affected eye

Explanation:

The correct answer is A. “bullseye” pattern on the anterior lens capsule is characteristic of pseudoexfoliation syndrome (PXF), where flaky material deposits on the anterior lens capsule, forming a bullseye or target appearance. PXF often leads to elevated intraocular pressure and can result in pseudoexfoliation glaucoma. B: Increased intraocular pressure with a closed angle on gonioscopy: This is more typical of angle-closure glaucoma. C: Dense corneal edema and severe pain: Acute angle-closure glaucoma is more likely.  D:  History of recurrent iritis: Uveitic glaucoma is more likely. 

Source:

https://eyerounds.org/cases/case8.htm#gsc.tab=0