Lens- Induced Glaucoma.pptx
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This document discusses several types of lens-induced glaucoma, including phacolytic glaucoma caused by leakage of lens proteins obstructing the trabecular meshwork, leading to elevated intraocular pressure (IOP). Lens particle glaucoma involves retention of lens material after surgery or trauma obstructing outflow. Phacoantigenic glaucoma occurs when patients become sensitized to their own lens protein. Phacomorphic glaucoma involves angle narrowing from the cataractous lens mass effect. Ectopia lentis is lens displacement that can cause pupillary block and angle closure. Treatment focuses on controlling IOP, reducing inflammation, and removing obstructing lens material through medication, iridotomy,
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This document summarizes various periorbital malpositions and involutional changes including ectropion, entropion, and symblepharon. Ectropion is outward turning of the eyelid and has several types including involutional, cicatricial, and paralytic. Entropion is inward turning and can be involutional, acute spastic, or cicatricial. Symblepharon is an adhesion between conjunctival surfaces caused by inflammation, infection, or trauma. The document discusses examination, risk factors, pathophysiology, and management options for each condition including surgical procedures and medical treatment.
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Lens- Induced Glaucoma.pptx
- 2. CLASSIFICATION • Lens induced Glaucoma • Phacolytic glaucoma • Lens particle glaucoma • Phacoantigenic glaucoma • Lens- Induced Angle closure • Phacomorphic glaucoma • Ectopia lentis
- 3. PHACOLYTIC GLAUCOMA • leakage of high-molecular weight lens protein through microscopic openings in the lens capsule of a mature or hypermature cataract • subsequently obstructs the trabecular meshwork • Elevated IOP occurs as a result of obstruction of the trabecular meshwork by high-molecular-weight proteins, lens-laden macrophages, and other inflammatory debris.
- 4. SIGNS & SYMPTOMS • sudden onset of pain • conjunctival hyperemia • worsening vision. • Examination reveals markedly elevated IOP, microcystic corneal edema, prominent cell and flare reaction without keratic precipitates • Tx: Ocular hypotensive medicat may be necessary to reduce the IOP; however, definitive therapy requires cataract extraction.
- 5. LENS PARTICLE GLAUCOMA • retention of lens material in the eye after cataract extraction, capsulotomy, or ocular trauma results in obstruction of the trabecular meshwork. • Lens particle glaucoma usually occurs within weeks of the initial surgery or trauma, but it may occur months or years later. • Clinical findings include: • cortical material in the anterior chamber • elevated IOP • moderate anterior chamber reaction • microcystic corneal edema • and, with time, posterior synechiae and peripheral anterior synechiae (PAS).
- 6. MANAGMENT 1. Control the IOP: • Using antiglaucoma medication, preferably those that decreases aqueous formation. 2. Prevent the synechia : • mydriatics to inhibit posterior synechiae formation 3. Reduce the Inflammation: • topical corticosteroids • If the IOP cannot be controlled, surgical removal of the lens material may be necessary.
- 7. PHACOANTIGENIC GLAUCOMA (AKA PHACOANAPHYLAXIS) • patients become sensitized to their own lens protein after surgery or penetrating trauma, resulting in a granulomatous inflammation. • The clinical picture: • moderate anterior chamber reaction with KPs on both the corneal endothelium and the anterior lens surface • low-grade vitritis, posterior synechiae, PAS, and residual lens material in the anterior chamber may be present. • Glaucomatous optic neuropathy may occur, but it is not common in eyes with phacoantigenic glaucoma.
- 8. MANAGMENT • Initiation of topical corticosteroids and aqueous suppressants are recommended. • to reduce the inflammation and IOP. The residual lens material will likely need to be removed once the inflammation is controlled.
- 9. PHACOMORPHIC GLAUCOMA • Mechanism: multifactorial. • significant component of the pathologic angle narrowing is related to the acquired mass effect of the cataractous lens itself. • pupillary block often plays an important role in this condition. • Slow narrowing vs Rapid ( pupillary block ) • Laser peripheral iridotomy (LPI) followed by cataract extraction in a quiet eye is the traditional treatment.
- 10. ECTOPIA LENTIS • displacement of the crystalline lens from its normal anatomic position. • With forward displacement, pupillary block may occur, resulting in iris bombé, shallowing of the anterior chamber angle, and secondary angle closure. • common causes of lens subluxation include: • pseudoexfoliation syndrome (most common) • trauma • Marfan syndrome • homocystinuria • microspherophakia • Weill-Marchesani syndrome • Ehlers-Danlos syndrome • sulfite oxidase deficiency
- 11. MANAGMENT • The treatment of choice is the creation of 2 laser iridotomies 180° apart so that both will not be occluded simultaneously by the lens.