Glaucoma · NEET PG Preparation Ophthalmology
A 45-year-old chronic smoker presents for a routine eye check-up. His visual acuity is 20/20 in both eyes. Intraocular pressure is 24 mmHg in the rig…
Practice question from Glaucoma (NEET PG Preparation Ophthalmology), with the correct answer and a step-by-step solution.
medium · MCQ · Q-46C9D6
A 45-year-old chronic smoker presents for a routine eye check-up. His visual acuity is 20/20 in both eyes. Intraocular pressure is 24 mmHg in the right eye and 22 mmHg in the left eye. Gonioscopy shows open angles (Shaffer grade 4) in all quadrants. Automated perimetry reveals normal visual fields, and the optic nerve head shows a cup-to-disc ratio of 0.3 with healthy neuroretinal rims. What is the most appropriate management at this stage?
- A.Initiate lifelong topical prostaglandin analogues immediately
- B.Perform immediate Laser Peripheral iridotomy (LPI)
- C.Observe and monitor with serial IOP checks, gonioscopy, and visual fieldsCorrect answer
- D.Perform trabeculectomy with mitomycin C
Solution
This patient has ocular hypertension (OHT), characterized by elevated IOP (>21 mmHg) with open angles, normal visual fields, and no optic disc damage. The risk of progression to primary open-angle glaucoma (POAG) is low, and routine large-scale clinical trials suggest that observation is appropriate unless specific risk factors (high vertical cup-disc ratio, thin central corneal thickness, family history) dictate treatment.
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