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A 40-year-old African female comes in complaining of decreased vision in the right eye. She denies any past ocular history, including no red eye, photophobia or trauma. The left eye appears normal.

1.	Given the history above, what may account for the patient’s decreased vision?
	d -- all of the above This patient has iridocorneal endothelial (ICE) syndrome. ICE syndrome is an acquired disease that is unilateral and tends to occur in middle-aged females. ICE syndrome is a spectrum of disease which is made up of 3 syndromes: Iris nevus syndrome, Chandler syndrome and Essential iris atrophy.  Chandler syndrome is characterized by corneal edema which may cause decreased vision.  Iris nevus syndrome and essential iris atrophy are both associated with corectopia which can lead to decreased vision if the iris obstructs the visual axis.  About half of those with ICE syndrome develop glaucoma which can compromise vision if not managed appropriately.
2.	The patient is noted to have elevated intraocular pressures. What is the most likely mechanism for this?
	e -- secondary angle closure glaucoma The above patient has iridocorneal endothelial (ICE) syndrome.  This is an acquired disorder in which the corneal endothelium takes on characteristics of epithelial cells and can grow across the angle structures and obstruct the trabecular meshwork causing secondary angle closure glaucoma.
3.	What is the best way to treat this patient’s elevated intraocular pressure?
	b -- aqueous suppressants As explained above in question #2, glaucoma is caused by a secondary angle-closure mechanism.  Miotics are not known to be effective in treating glaucoma due to ICE syndrome.  As the patient is not on any glaucoma medications, it would be more appropriate to begin medical management before surgical management is considered.