A 66 year old presents to emergency with sudden onset severe pain, blurring vision in right eye. Examination reveals decreased visual acuity with shallow cornea, hazy cornea in the same eye.Eye has a stony hard consistency.Likely diagnosis is:
**Core Concept**
The patient's presentation of sudden onset severe pain, blurring vision, shallow cornea, and a stony hard consistency of the eye is suggestive of a condition where there is an abnormal increase in intraocular pressure (IOP) due to blockage of the drainage of aqueous humor, leading to corneal edema and ischemia.
**Why the Correct Answer is Right**
The patient's symptoms and signs are classic for acute angle-closure glaucoma, where the iris is pushed forward, blocking the trabecular meshwork and preventing the outflow of aqueous humor. This leads to a rapid increase in IOP, causing corneal edema, ischemia, and eventually, vision loss. The pain is due to corneal ischemia and increased IOP. The stony hard consistency of the eye is due to corneal edema.
**Why Each Wrong Option is Incorrect**
**Option A:** Acute angle-closure glaucoma is a type of narrow-angle glaucoma, not a wide-angle glaucoma. Wide-angle glaucoma is often asymptomatic and has a more gradual progression.
**Option B:** Corneal ulcers can cause pain and vision loss, but they do not typically cause a stony hard consistency of the eye or a significant increase in IOP.
**Option C:** Endophthalmitis is an infection within the eye that can cause pain and vision loss, but it does not typically cause a stony hard consistency of the eye or a significant increase in IOP.
**Clinical Pearl / High-Yield Fact**
The "Triple Tree" sign is a classic clinical finding in acute angle-closure glaucoma, where the iris is pushed forward, blocking the trabecular meshwork. This sign is characterized by a triangular-shaped area of the iris that is ischemic and edematous, giving it a characteristic "treelike" appearance.
**Correct Answer: C. Endophthalmitis is an infection within the eye that can cause pain and vision loss, but it does not typically cause a stony hard consistency of the eye or a significant increase in IOP.