A patient complains of unilateral eye infections and pain, pressure over his eye, blurred and decreased visual acuity, seeing halos around lights, nausea and vomiting. He is likely to have?

1. A

   Acute angle-closure glaucoma

2. B

   Chronic open-angle glaucoma

3. C

   Cataract

4. D

   Retinal detachment

Appeared in: RAK Nursing Officer - 2019

Explanation

• The constellation of symptoms—sudden, severe unilateral eye pain, blurred vision, and seeing halos around lights—is the classic presentation of acute angle-closure glaucoma.
• The presence of systemic symptoms like nausea and vomiting is a key differentiator, caused by the rapid and significant increase in intraocular pressure (IOP) triggering a vasovagal response.
• This condition is an ophthalmic emergency because the extremely high IOP can cause rapid, irreversible damage to the optic nerve, leading to permanent blindness if not treated promptly.

Why Other Options Were Wrong

• Option B: Chronic open-angle glaucoma is typically a slow, progressive, and painless condition. It causes a gradual loss of peripheral vision over time and does not present with acute pain, halos, or nausea.
• Option C: A cataract involves a painless, gradual clouding of the eye's lens, leading to progressively blurry vision and increased glare, especially at night. It does not cause acute pain, pressure, or nausea.
• Option D: Retinal detachment is characterized by symptoms like seeing flashes of light (photopsia), a sudden increase in floaters, and a shadow or 'curtain' descending over the visual field. It is typically painless.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differential diagnosis of acute eye conditions to guide bedside assessment, documentation, and the next nursing action.
• Nurses must be able to rapidly identify the signs of acute angle-closure glaucoma, as it is an ophthalmic emergency where prompt intervention is critical to preserving the patient's sight.
• Initial nursing actions focus on reducing intraocular pressure and managing symptoms. This includes elevating the head of the bed, providing a calm and dark environment, administering prescribed medications, and preparing for urgent ophthalmological consultation.
• What if? - If the patient had described a 'curtain falling over their vision' and 'flashes of light' but no pain, the priority diagnosis would shift to retinal detachment. This is also an emergency but requires different interventions, such as specific head positioning to prevent further detachment.

How to Approach the Question

• First, analyze the key symptoms presented in the clinical scenario: sudden onset, unilateral eye, severe pain, pressure, blurred vision, halos, and systemic symptoms (nausea/vomiting).
• Recognize that this specific cluster of symptoms, particularly the combination of severe eye pain and systemic upset, points towards a serious, acute process.
• Evaluate each option based on its typical presentation. Chronic open-angle glaucoma and cataracts are gradual and painless, so they can be eliminated.
• Differentiate between the remaining acute conditions. Retinal detachment is characterized by flashes, floaters, and a 'curtain' effect, and is usually painless.
• Conclude that the patient's symptoms perfectly align with the classic description of acute angle-closure glaucoma, an ophthalmic emergency.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of acute eye conditions
• Stem keywords: unilateral eye, pain, pressure, blurred, visual acuity, halos around lights, nausea, vomiting
• Lead-in keywords: likely to have
• Clinical cues: The combination of acute, severe, unilateral eye pain with visual halos and systemic symptoms (nausea/vomiting) is a hallmark of an ocular emergency.
• Negative lead-in flag: false

Question ID

QIjQVO8BDvt7AJBOR5SEDQ

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 1 p. 266-268

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 96-98

E6 Medicine Macleod Clinical Examination 15e p. 180-182