Glaucoma: Sturge-Weber in adults: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Glaucoma: Sturge-Weber in adults

Sample item

A 35-year-old man with a facial port-wine stain has raised pressure in one eye. Gonioscopy shows a wide-open angle with blood visible in Schlemm canal. Which mechanism best explains the glaucoma?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Raised episcleral venous pressure from the vascular malformation

In adult-onset glaucoma with Sturge-Weber syndrome, the episcleral vessels shunt blood at higher pressure, so the pressure that aqueous must overcome rises. Blood reflux into Schlemm canal on gonioscopy is the clue. Infantile onset in the same syndrome is instead due to an angle anomaly.

Option by option

  • A. Trabeculodysgenesis from arrested neural crest migration

    Trabeculodysgenesis explains the infantile form, but it would not typically present first in a 35-year-old with blood in the canal.

  • B. Raised episcleral venous pressure from the vascular malformation (correct)

    Correct. Raised episcleral venous pressure and blood in Schlemm canal explain adult-onset glaucoma in this syndrome.

  • C. Reduced trabecular outflow from steroid exposure

    Steroid exposure is not described, and it would not produce blood in Schlemm canal.

  • D. Pupillary block caused by seclusio pupillae

    Seclusio pupillae causes pupillary block with a closed angle, but the angle here is wide open.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is B, Raised episcleral venous pressure from the vascular malformation. In adult-onset glaucoma with Sturge-Weber syndrome, the episcleral vessels shunt blood at higher pressure, so the pressure that aqueous must overcome rises.

Why is "Trabeculodysgenesis from arrested neural crest migration" not the answer?

Trabeculodysgenesis explains the infantile form, but it would not typically present first in a 35-year-old with blood in the canal.

Why is "Reduced trabecular outflow from steroid exposure" not the answer?

Steroid exposure is not described, and it would not produce blood in Schlemm canal.

Why is "Pupillary block caused by seclusio pupillae" not the answer?

Seclusio pupillae causes pupillary block with a closed angle, but the angle here is wide open.

What concept does this question test?

It tests Glaucoma: Sturge-Weber in adults in Ophthalmology. Blood reflux into Schlemm canal on gonioscopy is the clue. Infantile onset in the same syndrome is instead due to an angle anomaly.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Glaucoma: Sturge-Weber in adults?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.