Question

A 77 year old male patient comes to the clinic for complaints of cloudy vision, eye pain, headache and nausea and vomiting for the past two days. She is clearly anxious and visibly uncomfortable. During the examination, the NP notes mid-dilated pupils that are ovals shaped. The funduscopic examination also reveals cupping of the optic nerve. What diagnosis does the NP suspect?

a. Cataracts
b. Early stages of vision loss
c. Acute angle-closure glaucoma
d. Retinopathy

Answer 1

The symptoms and examination findings suggest that the patient is likely suffering from acute angle-closure glaucoma, requiring immediate treatment to prevent permanent vision loss. Other conditions like cataracts, retinopathy, and early stages of vision loss are less compatible with the acute presentation.

Step-by-step explanation:

The 77-year-old male patient presents with symptoms of cloudy vision, eye pain, headache, nausea, vomiting, mid-dilated pupils that are ovals shaped, and cupping of the optic nerve. These clinical signs are highly suggestive of acute angle-closure glaucoma, a condition where the fluid pressure inside the eye rises quickly due to a blocked drainage canal, leading to these acute symptoms. This condition is a medical emergency and requires immediate attention to prevent permanent vision loss.

Given the age of the patient and the presence of a cloudy lens, cataracts may also be considered, but they typically develop slowly and don't cause acute symptoms like headache and nausea. Retinopathy and early stages of vision loss do not present with the acute symptoms and mid-dilated oval pupils seen in this patient. Therefore, these conditions are less likely.

Those over 40 years of age should have their intraocular pressure tested routinely. Glaucoma is related to excessive intraocular pressure, which can be detected through various measurement methods, including a noncontact approach using a puff of air.