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Differential Diagnosis for a Patient with Fixed Dilated Pupil and Past History of Cataract Surgery

  • Single Most Likely Diagnosis
    • Uveitic glaucoma or iris damage from previous cataract surgery: This condition is a common complication following cataract surgery, especially if there was trauma to the iris during the procedure. The fixed dilated pupil could be a result of iris damage or uveitic glaucoma causing the iris to become adherent to the lens or vitreous, leading to a fixed pupil.
  • Other Likely Diagnoses
    • Posterior synechiae: Adhesions between the iris and the lens can occur after cataract surgery, especially if there was inflammation. These adhesions can cause the pupil to become fixed in position.
    • Iris atrophy: Previous surgeries, especially if complicated, can lead to atrophy of the iris, resulting in a dilated pupil that does not react to light.
    • Intraocular lens (IOL) malposition: If the IOL is not properly positioned, it can cause mechanical damage to the iris, leading to a fixed dilated pupil.
  • Do Not Miss Diagnoses
    • Endophthalmitis: Although less likely, endophthalmitis (infection within the eye) is a serious condition that can occur after cataract surgery. Symptoms might include severe eye pain, redness, and vision loss, in addition to a fixed dilated pupil.
    • Retinal detachment: This is a medical emergency that can occur after cataract surgery. While the primary symptom is usually vision loss, in some cases, it might be accompanied by a fixed dilated pupil due to associated retinal or vitreous traction on the iris.
  • Rare Diagnoses
    • Tonic pupil (Adie's pupil): A rare condition characterized by a dilated pupil that reacts poorly to light. It is usually benign but can be mistaken for more serious conditions.
    • Iris melanoma: A rare tumor of the iris that could potentially cause a fixed dilated pupil if it involves the iris sphincter or if it causes secondary glaucoma.
    • Chronic uveitis: Long-standing inflammation within the eye can lead to complications such as a fixed dilated pupil due to scarring and adhesions within the eye.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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