An elderly male who has a history of glaucoma, on examination shows bulging of cornea. What is the diagnosis?
**Core Concept**
The question tests the understanding of the relationship between intraocular pressure (IOP) and the structural changes in the eye, specifically in the context of glaucoma. Glaucoma is characterized by increased IOP, which can lead to damage to the optic nerve and vision loss. The bulging of the cornea, also known as corneal edema, is a sign of acute angle-closure glaucoma.
**Why the Correct Answer is Right**
In acute angle-closure glaucoma, the iris is pushed forward, blocking the drainage angle of the eye and causing a sudden increase in IOP. This leads to corneal edema, which is visible as bulging of the cornea. The increased IOP also causes the cornea to become edematous due to the breakdown of the blood-aqueous barrier and the influx of fluid into the cornea. This condition requires immediate medical attention to prevent permanent vision loss.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not relevant to the clinical presentation of glaucoma and corneal bulging.
**Option B:** While hypertension can have systemic effects, it is not directly related to the acute presentation of glaucoma and corneal bulging.
**Option C:** This option is incorrect because it does not address the specific clinical finding of corneal bulging in the context of glaucoma.
**Clinical Pearl / High-Yield Fact**
Acute angle-closure glaucoma is a medical emergency that requires prompt treatment to prevent permanent vision loss. The classic symptoms include severe eye pain, headache, nausea, and vomiting, in addition to corneal bulging.
**Correct Answer:** D. Acute angle-closure glaucoma.