We will discuss about various kind of lens related glaucoma.

1. Lens Induced
Glaucoma
Dr. Habiba Sultana Sumi

2. Classification system
1.Phacomorphic glaucoma.
2.Dislocated lens.
3.Phacolytic glaucoma.
4.Lens particle glaucoma.
5.Phacoanaphylactic glaucoma.

3. Phacomorphic glaucoma
• It is the secondary angle closure glaucoma
precipitated by an intumescent cataractous lens.
• Mechanism :
 Growing intumescent lens pushes the iris
forward ,enhancing pupillary block and leading to
angle closure.
 The convex iris shape due to increased lens vault
resembles a volcano on gonioscopy and often
referred to as the “Mount Fuji Sign”.

4. Diagnosis
• Presentation is similar to acute PACG
with shallow AC.
• Mid dilated pupil with cataract.
• Fellow eye has deep AC and open angle.

5. Treatment :
-Cataract extraction is the main treatment.
-Laser PI relieve the acute attack.
-Laser iridoplasty is also effective for rapid control of
IOP.

6. Phacolytic glaucoma
• It is a secondary open angle glaucoma occurs in
association with hypermature cataract.
Mechanism:
-Lens protien leaks through intact lens
capsule,macrophages laden with phagocytosed lens
material and also high molecular weight proteins
accumulate at the TM and block aqueous outflow and
elevates IOP.

8. Treatment
•After medical management,cataract
extraction with posterior chamber IOL
implantation.
•Combined trabeculectomy can also
considered in patients with long
duration of symptoms.

9. Lens particle glaucoma
• Mechanism: After traumatic(or surgery) capsular
disruption lens material may migrate into the AC and
mechanically block the aqueous outflow pathway.
Inflammatory reaction to the lens material may cause
PS,PAS or pupillary block.
• Classic signs of lens particle glaucoma is
- White lens material in the AC ,
-Elevated IOP and
-Open angle.

11. • Histologic study of anterior chamber fluid may
demonstrate foamy macrophages mixed with lens
particles.
• Treatment:
-Topical steroid,
-Anti glaucoma medication
-Cycloplegics
-Cataract extraction and removal of lens material.

12. Phacoanaphylactic glaucoma
• It is a chronic granulomatous
reaction to lens material
retained in the eye.
• Inflammation occurs in the
primary eye or in the fellow
eye to lens particle exposure
after trauma.
• KP on the corneal endothelium
is a distinguishing feature.

13. Phacoanaphylactic glaucoma
Treatment:
Surgical lens material removal is indicated
if medical therapy is unsuccessful.