Unusual presentation of phacolytic glaucoma: simulating microbial keratitis

Area of Science:

• Ophthalmology
• Pathology

Background:

• Phacolytic glaucoma is typically diagnosed based on specific clinical signs and differential diagnoses.
• Cataractous lens material leaking into the anterior chamber can trigger a significant inflammatory response.

Observation:

• An unusual case presented with severe photophobia, pain, and redness, mimicking a deep corneal abscess.
• A dislocated cataractous lens adhered to the corneal endothelium, eliciting a cellular reaction.
• Anterior chamber wash revealed the lens embedded within an infiltrate.

Findings:

• Histopathological examination confirmed inflammation, a histiocytic response, and giant cells around the lens material.
• These findings indicated an ongoing phacolytic process, despite the atypical clinical presentation.
• Surgical removal of the lens and surrounding infiltrate led to symptom resolution.

Implications:

• This case highlights the importance of considering phacolytic glaucoma in atypical presentations, even when mimicking other conditions like corneal abscess.
• Early surgical intervention by removing the inciting lens material is crucial for managing such inflammatory glaucoma.
• Accurate histopathological examination aids in confirming the diagnosis and understanding the inflammatory cascade.