& x20;Krukenberg spindle formation on the corneal endothelium is a characteristic finding of which type of gl… - INI-CET EXAM -2025

INI-CET EXAM -2025

Medical & Surgical Nursing

Easy

Appeared in: INI-CET EXAM -2025

Explanation

A Krukenberg spindle is a vertical, spindle-shaped line of brownish pigment deposited on the posterior surface of the cornea (endothelium).
This deposition occurs due to the shedding of pigment from the posterior iris surface, a process central to Pigment Dispersion Syndrome.
Pigment Dispersion Syndrome leads to Pigmentary Glaucoma when the shed pigment clogs the trabecular meshwork, elevating intraocular pressure and damaging the optic nerve.
Therefore, the presence of a Krukenberg spindle is a pathognomonic or characteristic sign of Pigmentary Glaucoma.

Option B: Malignant glaucoma (or aqueous misdirection syndrome) is caused by the abnormal flow of aqueous humor into the vitreous cavity, which pushes the lens and iris forward, causing a secondary angle closure. It is not related to pigment deposition.
Option C: Acute angle closure glaucoma is an emergency caused by the sudden physical obstruction of the eye's drainage angle by the peripheral iris. It presents with severe pain, blurred vision, and a rapid rise in pressure, not the chronic signs of pigment deposition.
Option D: Neovascular glaucoma is caused by the growth of new, abnormal blood vessels (neovascularization) over the iris and into the drainage angle, which then contract and close the angle. This is typically a complication of retinal ischemia from conditions like diabetic retinopathy or central retinal vein occlusion.

Visual 1: Slit-lamp photograph - A clear image showing a Krukenberg spindle on the corneal endothelium. This helps the learner visualize the specific vertical pattern of pigment deposition being described.
Visual 2: Diagram - An illustration of the anterior chamber of the eye showing the pathway of pigment shedding from the posterior iris, its circulation in the aqueous humor, and its deposition on the cornea and trabecular meshwork.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of glaucoma subtypes as background academic context rather than a clinical decision trigger.
Identifying a Krukenberg spindle during a routine eye exam is a critical diagnostic clue that should prompt a full glaucoma workup, including measurement of intraocular pressure and assessment of the optic nerve.
Pigmentary glaucoma often affects younger (20s-40s), myopic (nearsighted) males, a different demographic than primary open-angle glaucoma, making recognition of its unique signs essential for early diagnosis.
What if? If a patient has pigment on the cornea but it is scattered diffusely or in clumps (keratic precipitates) rather than a vertical spindle, and the patient has signs of inflammation (redness, pain, cells in the anterior chamber), the diagnosis would shift towards uveitis-related glaucoma, not pigmentary glaucoma.

How to Approach the Question

First, identify the key term in the question stem: 'Krukenberg spindle'. This is a specific clinical sign.
Recall the definition of a Krukenberg spindle: a vertical deposition of pigment on the corneal endothelium.
Connect the sign to its underlying pathophysiology. The presence of free-floating pigment in the anterior chamber points to a pigment dispersion process.
Evaluate the options to see which type of glaucoma is defined by pigment dispersion.
Pigmentary Glaucoma is directly caused by pigment from the iris clogging the eye's drainage system.
Eliminate the other options by recalling their distinct causes: Malignant (aqueous misdirection), Acute Angle Closure (physical blockage), and Neovascular (new blood vessel growth).

Concept Tested & Keywords

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