Secondary glaucoma can occur due to various causes that obstruct the normal outflow of aqueous humor from the eye. These include lens-induced glaucomas caused by hypermature cataracts releasing proteins that block outflow pathways and cause increased intraocular pressure (IOP). Other causes are ectopia lentis where the displaced lens causes pupillary block, retained lens particles after cataract surgery or trauma blocking trabecular meshwork outflow, and rare phacoantigenic uveitis from an inflammatory reaction. Treatment focuses on acute IOP lowering followed by surgical removal of the causative lens material when possible.

1. SECONDARY
GLAUCOMA
By: Qurat-ul-ain
Ophthalmic Medical
Technologist/ MBA Health
& Hospital management

2. Secondary
glaucoma
Lens-induced
glaucoma
Phacomorphic
Phacolytic
Lens particle
Ectopia lentis
Phacoantigenic
uveitis
Aphakic

3. HMW lens
proteins
• Released through microscopic
defects in the intact capsule of
hypermature lens
Causes
obstruction
of outflow
pathways Results in
blockage at
the angle of
AC
• Leads to  IOP
MECHANISM OF
PHACOLYTIC
GLAUCOMA

4. SYMPTOMS:
Acute ocular pain
Slow vision loss
history prior to the
acute onset of pain
Inaccurate light
perception due to
the density of
cataract
SIGNS:
Conjunctival hyperemia
Corneal edema
AC depth normal or deep
AC containing flare,
aqueous cells
Precipitate on the corneal
endothelium
Sluggish pupil
Hypermature/
morgagnian cataract
TREATMENT & MANAGEMENT:
Acute lowering of IOP by:
Combination of topical &
systemic IOP lowering agents.
Hyperosmotic agents
Systemic carbonic anhydrase
inhibitors
Topical beta blockers
Prednisolone acetate eye drops
Cycloplegic drugs
Cataract extraction under
mannitol followed by steroid
cover
CLINICAL PICTURE & PRINCIPLES
OF MANAGEMENT

5. Acute angle-
closure
glaucoma
• By an intumescent cataract
Slackens the
suspensory
ligaments &
allows lens to
move anteriorly Leads to the
iridolenticular
contact by ant-post
lens growth.
MECHANISM OF
PHACOMORPHIC
GLAUCOMA
• Equatorial age related growth of the lens
• Potentiates pupillary
block & iris bombe’
formation.

6. SYMPTOMS:
Similar to
PACG
SIGNS:
Shallow anterior
chamber
Mid dilated pupil
Dense white
cataract is
evident.
TREATMENT & MANAGEMENT:
Reduce IOP
Cataract extraction
Should be handled as an
emergency
Combination of topical &
systemic IOP lowering agents.
Topical steroids
Prednisolone acetate 1%
CLINICAL PICTURE & PRINCIPLES
OF MANAGEMENT

7. IOP
elevation
• By obstruction of aqueous outflow
d/t retained lens matter.
Secondary open
angle glaucoma
May occur after cataract
surgery, trauma or YAG
posterior capsulotomy
MECHANISM OF LENS-
PARTICLE GLAUCOMA:
• Grossly disrupted lens material in the
anterior chamber

8. SYMPTOMS:
Acute rise in
IOP
SIGNS:
TM blocked by
the lens particles
floating in
aqueous humor
Diagnosis from
history of trauma
and surgery
TREATMENT &
MANAGEMENT:
Topical & systemic pressure
lowering drugs.
Mydriatics to inhibit
posterior synechia
formation.
Topical steroids
Surgical removal of retained
lens matter if IOP not
controlled by medical
management.
CLINICAL PICTURE & PRINCIPLES
OF MANAGEMENT

9. Acute
inflammatory
reaction due to
antigen-antibody
• Rarest type of lens-induced glaucoma
Granulomatous
inflammation
Raised IOP
MECHANISM OF
PHACO-ANTIGENIC
GLAUCOMA:
• Preceding disruption of lens capsule by
cataract extraction, penetrating injury
• Due to inflammatory
reaction of uveal tissue

10. SYMPTOMS:
Sensitized
with own
lens proteins
SIGNS:
Eyelid edema
Conjunctival
injection
Corneal edema
An intense AC
reaction
Post. Synechiae
Mutton fat keratitic
precipitates
Ant. uveitis
TREATMENT &
MANAGEMENT:
Topical steroid therapy
Anti-glaucoma medication
Surgical intervention if
necessary
CLINICAL PICTURE & PRINCIPLES
OF MANAGEMENT

11. Lens
displacement
Pupillary block
resulting in iris
bombe
Shallowing of
ACA resulting
in  IOP
MECHANISM OF
ECTOPIA LENTIS
GLAUCOMA:
TREATMENT:
Lensectomy to
restore vision
& reduce the
risk of
recurrent
pupillary
block

12. Intact
vitreous face
Block the pupil
or an iridotomy
site Leads to
sec. angle
closure
glaucoma
MECHANISM OF
APHAKIC/
PSEUDOPHAKIC
GLAUCOMA:
TREATMENT:
IV hyperosmotic
agents
Removal of
viscoelastic
substances
PC-IOL
Anti-
cholinesterase
agents
intraoperatively
Iridotomy

13. NEOVASCULAR GLAUCOMA
CAUSES:
Ischemic CRVO
DM
Arterial retinal
vascular disease
Long standing
retinal detachment
Intraocular tumors
SIGNS:
Corneal edema
Raised IOP
Flares & cells in AC
Subtle vessels on the pupillary
margin
New vessels on surface of the
iris
TREATMENT:
Medical treatment
of raised IOP
Panretinal
photocoagulation
RD surgery 3PPPV
Anti-VEGF
Trab with shunts
Ciliary body
ablation
Enucleation

14. INFLAMMATORY GLAUCOMA
Sec. ANGLE CLOSURE
CAUSES:
As a result of ocular
inflammation.
Fibrin &  aqueous
proteins d/t
breakdown of blood-
aqueous barrier
Posterior synechiae
TYPES:
Pseudoexfoliation
syndrome
Pigment dispersion
syndrome
Posner schlossman
syndrome
FUCHS heterochromia
uveitis
Traumatic hyphema
Hemolytic & ghost cell
glaucoma
Angle recession
glaucoma
Steroid induced
glaucoma
Sec. OPEN ANGLE
CAUSES:
Edema of trabecular
meshwork
Endothelial cell
dysfunction
Fibrin or
inflammatory cells
blocking aqueous
outflow

15. THANK YOU!