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A 60-year-old male with a history of colon cancer presents with a 2-day history of persistent, severe right eye pain and decreased vision. He has no other complaints. His temperature is 99.3 °F, blood pressure is 130/80 mmHg, and pulse is 82/min.

On examination, he has a fixed, mid-dilated pupil and ciliary injection of the right eye. Slit-lamp examination shows corneal edema, conjunctival injection, and a shallow anterior chamber.

What is the most appropriate next step in management?

A. Aqueous humor paracentesis
B. Intravenous acyclovir and oral prednisone
C. Emergent ophthalmology consultation
D. Emergent head CT
E. Larynx

Answer :

Final answer:

The patient's presentation is indicative of acute angle-closure glaucoma and requires an emergent ophthalmology consultation to prevent further damage to the eye and preserve vision.

Explanation:

The 60-year-old male with a history of colon cancer presenting with severe right eye pain, decreased vision, a mid-dilated pupil, ciliary injection, corneal edema, conjunctival injection, and a shallow anterior chamber is likely experiencing acute angle-closure glaucoma. A fixed, mid-dilated pupil and a shallow anterior chamber are classic signs of this condition. High intraocular pressure can lead to optic nerve damage and vision loss if not treated promptly.

The most appropriate next step in management is (C) Emergent ophthalmology consultation. Immediate assessment by an ophthalmologist is crucial for determining the best course of treatment to prevent further damage and to preserve vision. Aqueous humor paracentesis may be a part of the therapeutic intervention but is not the initial step. Intravenous acyclovir and oral prednisone would be used for herpetic eye diseases, not glaucoma, and an emergent head CT would be indicated if there were suspicion of central nervous system pathology, which is not primarily indicated in this case.

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