OPHTHALMOLOGY SDL FINAL.pptx Diphu Medical College and Hospital

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1. EYE: SDL: OP6.7: Enumerate and discuss the aetiology , the clinical distinguishing features of shallow and deep anterior chamber. Choose appropriate investigations for patients with above conditions of the anterior chamber. FINAL YEAR MBBS--- OPTHALMOLOGY SDL CLASS DIPHU MEDICAL COLLEGE & HOSPITAL, DIPHU DATE: 24/ 09/ 2025

2. Aetiology of Shallow Anterior Chamber – Physiological/Anatomical Key Causes: Hypermetropia ( hyperopia ): Short axial length leads to crowding. Advancing age : Lens thickening and anterior shift. Nanophthalmos : Small eye globe with normal lens size. High hyperopia or hypermature cataract : Lens swelling ( intumescence ).

3. Aetiology of Shallow Anterior Chamber – Pathological Key Causes: Pupillary block: Primary angle-closure glaucoma mechanism. Plateau iris syndrome: Anterior iris root insertion. Lens-related : Anterior subluxation or dislocation. Posterior issues: Choroidal effusion/detachment . Trauma or iridocorneal endothelial syndrome.

4. Aetiology of Deep Anterior Chamber Key Causes: Myopia: Long axial length elongates chamber. Aphakia or pseudophakia : Lens removal/posterior shift. Megalocornea / keratoglobus : Enlarged anterior segment. Buphthalmos : In congenital glaucoma, eye enlargement. Lens posterior dislocation or reverse pupillary block.

5. Clinical Distinguishing Features – Shallow Anterior Chamber Key Features: Slit-lamp: Reduced central/peripheral depth; iris bombe (bowing). Van Herick grading : Grade 1–2 (narrow peripheral AC). Narrow angle ; risk of closure with symptoms like halos, pain. Associated : Shorter axial length , thicker lens. Symptoms : Acute glaucoma attacks if closed.

6. Clinical Distinguishing Features – Deep Anterior Chamber Key Features: Slit-lamp: Increased space; flat iris. Van Herick grading: Grade 4 (wide peripheral AC). Wide open angle ; lower glaucoma risk but myopia complications. Associated : Longer axial length, thinner lens. Often asymptomatic; may link to retinal issues.

7. Appropriate Investigations – Slit-lamp biomicroscopy : Initial assessment of depth and iris. Gonioscopy : Views angle structures; gold standard. Anterior Segment OCT (AS-OCT ): Quantitative ACD measurement, non-contact. Ultrasound Biomicroscopy (UBM): Details ciliary body/lens position. A-scan biometry : Axial length and ACD.

8. Investigations – Based on Condition For Shallow AC: Suspect angle-closure: Gonioscopy + IOP + AS-OCT for depth/angle. Lens/ choroidal issues : UBM to visualize posterior structures. For Deep AC: Suspect myopia/ aphakia : A-scan for axial length; fundus exam for retina. Anomalies like megalocornea : AS-OCT + corneal topography. IOP & pachymetry if glaucoma suspected .

9. Case Scenario: 55-year-old female: Acute red eye, headache, blurred vision with colored halos. On Examination: Shallow central ACD (2.0 mm), elevated IOP (45 mmHg), narrow angle on gonioscopy . DIAGNOSIS: ????

10. Diagnosis: Acute primary angle-closure glaucoma due to pupillary block.