Other findings

❖ The cornea is dull and steamy with epithelial edema.

❖ The anterior chamber is shallow or completely collapsed. This will be apparent when the eye is illuminated by a focused lateral light source (Fig. 1.12, p. 12) and upon slit-lamp examination. Inspection of the shallow anterior chamber will be difficult. Details of the surface of the iris will be visible, and the iris will appear faded.

❖ The fundus is generally obscured due to opacification of the corneal epithelium. When the fundus can be visualized as symptoms subside and the cornea clears, the spectrum of changes to the optic disk will range from a normal vital optic disk to an ill-defined hyperemic optic nerve. In the latter case, venous congestion will be present. The central artery of the retina will be seen to pulse on the optic disk as blood can only enter the eye during the systolic phase due to the high intraocular pressure.

❖ Visual acuity is reduced to perception of hand motions.

Differential diagnosis: Misdiagnosis is possible as the wide variety of symptoms can simulate other disorders.

❖ General symptoms such as headache, vomiting, and nausea often predominate and can easily be mistaken for appendicitis or a brain tumor.

❖ In iritis and iridocyclitis, the eye is also red and the iris appears faded. However, intraocular pressure tends to be decreased rather than elevated.

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