Rosh Internal Medicine Boost Practice Exam

A 65-year-old woman exhibits severe eye pain, a dilated right pupil, and increased intraocular pressure. What is the likely diagnosis?

1. Acute uveitis

2. Angle-closure glaucoma

3. Corneal abrasion

4. Open-angle glaucoma

The correct answer is: Angle-closure glaucoma

The presentation of severe eye pain, a dilated right pupil, and increased intraocular pressure is highly indicative of angle-closure glaucoma. This condition occurs when the drainage angle of the eye becomes blocked, preventing aqueous humor from properly exiting the eye. As a result, intraocular pressure rises sharply, leading to symptoms such as severe ocular pain, headache, nausea, and vomiting, as well as the physical findings of a mid-dilated pupil and corneal edema. In angle-closure glaucoma, the pupil is often mid-dilated due to the involvement of the iris and ciliary body. This contrasts with other conditions such as acute uveitis, where the pupil might be constricted and there would typically be associated redness and photophobia. Corneal abrasion would present with pain but usually without significant changes in pupil size or intraocular pressure. Open-angle glaucoma tends to develop more insidiously and generally does not produce acute symptoms or sudden increases in intraocular pressure. Given these considerations, the combination of severe eye pain, a dilated pupil, and elevated intraocular pressure strongly supports a diagnosis of angle-closure glaucoma.