Question 2: Based on the initial history and examination, what is your working diagnosis?

Question 2: Based on the initial history and examination, what is your working diagnosis?

Answer:

The most likely initial diagnosis is pigment dispersion syndrome (PDS), pigmentary ocular hypertension, or pigmentary glaucoma. While PDS typically affects younger (20-45 year old) Caucasian males, the patient may have had the condition for some time before presenting.

Characteristic features of PDS include::

• Kruckenberg’s spindle
• Spoke-like mid-peripheral iris transillumination defects
• Posterior bowing of the iris, heavily pigmented trabecular meshwork, and a darkly pigmented line anterior to the trabecular meshwork (Sampaolesi’s line)

Although the patient’s history of using eye drops suggests a possible prior diagnosis of pigmentary glaucoma, further testing is necessary for confirmation. It is crucial to assess the structure and function of the optic nerve. Clinical optic disc assessment, visual fields and OCT of the peripapillary retinal nerve fibre layer and macular were also performed.

End of answer