Which condition is among the three major etiologies presenting with unilateral anterior chamber cells and acutely elevated IOP?

Which condition is among the three major etiologies presenting with unilateral anterior chamber cells and acutely elevated IOP?

• A. Posner-Schlossman syndrome
• B. Acute angle-closure glaucoma
• C. Fuchs' heterochromic iridocyclitis
• D. Herpes zoster ophthalmicus

Answer: (A)

Posner-Schlossman syndrome, a glaucomatocyclitic crisis, is the classic scenario for unilateral anterior chamber cells with a sudden, markedly elevated intraocular pressure. The inflammation is mild (only a few cells and light flare) in the anterior chamber, yet the IOP can spike dramatically, and attacks tend to be episodic and one-sided. This combination—unilateral AC cells plus an acute IOP rise with relatively quiet inflammation—fits this condition best. Acute angle-closure glaucoma, while it can raise IOP acutely, presents with severe eye pain, redness, a hard eye, a mid-dilated fixed pupil, corneal edema, and a shallow anterior chamber, which goes beyond the mild anterior chamber reaction described. Fuchs' heterochromic iridocyclitis is typically a chronic, low-grade uveitis with heterochromia and minimal inflammation; IOP is usually normal or only intermittently elevated, not the abrupt spike seen in Posner-Schlossman. Herpes zoster ophthalmicus can cause anterior uveitis and IOP elevation, but it comes with a characteristic dermatomal vesicular rash and other signs of viral keratoconjunctivitis, not the classic unilateral, predominantly inflammatory-without-structural signs pattern of this presentation. So, the combination of a unilateral, mild anterior chamber reaction with an acute spike in IOP best points to Posner-Schlossman syndrome as one of the principal etiologies described.

Posner-Schlossman syndrome, a glaucomatocyclitic crisis, is the classic scenario for unilateral anterior chamber cells with a sudden, markedly elevated intraocular pressure. The inflammation is mild (only a few cells and light flare) in the anterior chamber, yet the IOP can spike dramatically, and attacks tend to be episodic and one-sided. This combination—unilateral AC cells plus an acute IOP rise with relatively quiet inflammation—fits this condition best.

Acute angle-closure glaucoma, while it can raise IOP acutely, presents with severe eye pain, redness, a hard eye, a mid-dilated fixed pupil, corneal edema, and a shallow anterior chamber, which goes beyond the mild anterior chamber reaction described. Fuchs' heterochromic iridocyclitis is typically a chronic, low-grade uveitis with heterochromia and minimal inflammation; IOP is usually normal or only intermittently elevated, not the abrupt spike seen in Posner-Schlossman. Herpes zoster ophthalmicus can cause anterior uveitis and IOP elevation, but it comes with a characteristic dermatomal vesicular rash and other signs of viral keratoconjunctivitis, not the classic unilateral, predominantly inflammatory-without-structural signs pattern of this presentation.

So, the combination of a unilateral, mild anterior chamber reaction with an acute spike in IOP best points to Posner-Schlossman syndrome as one of the principal etiologies described.