A 55yr old female presented to OPD with complain of pain in LE for 20 days VA=RE 6/24, LE-HM NCT=RE 30, LE 8 mm of Hg CCT=RE 554, LE 721 micron On examination - Slit lamp RE-cornea clear,AC shallow, Pupil normal size n normal reactive, lens NSII LE-diffuse bleb superiorly, cornea stromal edema, pupil fixed n mid dilated,AC normal n quite, pciol in place Rest details not clear Direct ophthalmoscopy RE- CD ration 0.6,deep cup, bayonetting sign present LE-Red glow absent, media hazy Gonio RE-No structure seen Final diagnosis and what should be the management?


Right eye sounds like Primary Angle closure. I'm not so sure if the disc is Glaucomatous because a 0.6 cup, deep cup and bayonetting can all be physiological. Also, u have not mentioned the appearance of the angle after indentation and whether PAS is present or not. Anyway the first line of management is to do a laser PI. This should open up the angle if there is no PAS. Then do a field or OCT of the RNFL later on to decide further course of management. As for the left eye, the pic is not clear but it looks like there is corneal edema, as I can see DM folds on the cornea. Treat symptomatically with antibiotic steroids, hypertonic saline, lubricating drops. If this doesn't work then the cornea is probably decompensated and u may have to think about keratoplasty. Do a B scan to rule out posterior segment problems. One thing to note is that the IOP measured in an edematous cornea will be false low. I don't think there is any point managing the PCO with laser till the corneal condition improves and u can attempt a fundoscopy to ascertain the visual prognosis.

Rt eye chronic angle closure glaucoma : Rx : * laser iridectomy. * timolol drops sos . Left eye : Possibilities r : * untreated , neglected iridocycltis leading to hazy media , low iop ,Stromal ( not epithelial ) edema & pain. * over filtration leading to low iop & pain in eye . * posterior capsule opacification adding to dimness of vn caused by other causes. * long standing retinal detachment leading to iridocyclitis & low iop. * Only stromal edema without epithelial bullae is unlikely to cause pain in eye . * rx : ( lt eye ). * Steroid with antibiotics e/drops. * atropine e/drops. * Dark glasses. * oral steroid. * oral nsaid. ( Hypersonic saline is not indicated in absence of epithelial edema .)

RE has primary angle closure glaucoma.. do a PI and if iop doesnt fall wnl start topical b blockers.. LE ask about surgical history.. bleb is not visible in the pics but iop is low.. its a complicated pseudophakia with corneal edema ac reaction thick pco.. do a b scan.. start topical steroid antibiotic combination along with cycloplegics

there are certain contradiction in the findings in the LE. ...bleb (is it surgical or postop), ac of normal depth and quiet, corneal edema, low IOP. My queries are: date of surgery nature of surgery preop evaluation and status of the tissues of the LE

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It looks like pseudophakic bullous keratopathy. Findings In favour of PBK are corneal edema, shallow ac, pupil mid dilated fixed. But nct in left eye 8mm Hg is contradictory. Left eye cct may be high due to corneal edema. There appears to be Posterior capsule opacification due to which there is no fundus glow.

RE primary angle closure glaucoma.. PI will be helpful. Perimetry should be done to assess fields and decide on surgery.LE low tension may be surgery induced. corneal edema can be attributed to PBK. try hypertonic saline to reduce corneal edema..Reassess tension and angles in LE


Dr. Manbir Singh sir please give your opinion

for RE do a PI.. left eye do a b scan and start topical steroids and cycloplegics

RE - angle cut closer glucoma LE - complicated pseudophakic ,PBK and associate with RD or choridal effusion. Adv - B scan

If glow is absent and iop is 8mmhg, vn HM only, i suspect RD.

If it's operated recently consider TAS....