report on lens Induced glaucoma

1. Lens Induced Glaucoma

2. Lens-induced Glaucoma
● The lens may cause both open-angle and angle-closure glaucoma
● open-angle lens-induced glaucomas
○ Phacolytic glaucoma
○ Lens particle glaucoma
○ Phacoantigenic glaucoma
● Closed-angle lens-induced glaucoma
○ Phacomorphic glaucoma
○ Ectopia lentis

3. Phacolytic Glaucoma
● an inflammatory glaucoma caused by the leakage of lens protein through
the capsule of a mature or hypermature cataract
● The proteins precipitate a secondary glaucoma
○ along with phagocytizing macrophages and other inflammatory debris,obstruct the
trabecular meshwork

4. ● Examination
○ poor vision(elderly)
○ sudden onset of pain
○ conjunctival hyperemia
○ worsening vision

5. ● Examination
○ markedly elevated lOP
○ microcystic corneal edema
○ prominent cell and flare reaction without keratic precipitates (KP)
■ lack of KP helps distinguish phacolytic glaucoma from phacoantigenic glaucoma
○ open anterior chamber angle

6. ● Examination
○ Cellular debris may be seen layered in
the anterior chamber angle
○ pseudohypopyon may be present
○ Large white particles (clumps of lens
protein) may also be seen in the anterior
chamber
○ mature or hypermature (morgagnian)
cataract is present

7. ● Treatment
○ IOP control
○ Cataract Extraction

8. Lens Particle Glaucoma
● lens cortex particles obstruct the trabecular meshwork following
○ cataract extraction
○ Capsulotomy
○ ocular trauma
● The severity of lOP elevation depends on
○ quantity of lens material released
○ degree of inflammation
○ ability of the trabecular meshwork to clear the lens material
○ functional status of the ciliary body(often altered following surgery or trauma)

9. ● Lens particle glaucoma
usually occurs within weeks
of the initial surgery or
trauma, but it may occur
months or years later

10. ● Examination
○ free cortical material in the anterior chamber
○ elevated lOP
○ moderate anterior chamber reaction
○ microcystic corneal edema
○ development of posterior synechiae and peripheral anterior synechiae

11. ● Treatment
○ control the lOP while the residual lens material resorbs
○ mydriatics to inhibit posterior synechiae formation
○ topical corticosteroids to reduce inflammation.
○ If the lOP cannot be controlled, surgical removal of the lens material is necessary

12. Phacoantigenic glaucoma
● (previously known as phacoanaphylaxis) is a rare entity in which patients
become sensitized to their own lens protein following surgery or
penetrating trauma, resulting in a granulomatous inflammation

13. ● Examination
○ moderate anterior chamber reaction with KP on both the corneal
endothelium and the anterior lens surface
○ a low-grade vitritis
○ synechial formation
○ residual lens material in the anterior chamber may be found
○ Glaucomatous optic neuropathy(may occur but not common)

14. ● Treatment
○ corticosteroids to reduce inflammation
○ aqueous suppressants to reduce lOP
○ If medical treatment is unsuccessful, residual lens material should be
removed

15. Lens-induced Glaucoma
● Lens-Induced Angle -Closure Glaucoma
○ Phacomorphic glaucoma
○ Ectopia lentis
● Intumescent or dislocated lenses( complete zonular dehiscence) may increase pupillary block and
cause angle closure

16. ● Phacomorphic glaucoma
○ pathological angle narrowing is related
to the acquired mass effect of the
cataractous lens itself
○ As with primary angle closure, pupillary
○ block often plays an important role in
this condition

17. ● Ectopia lentis
○ displacement of the lens from its normal
anatomical position
○ forward displacement, pupillary block
may occur, resulting in iris bombe and
shallowing of AC