Lens related Glaucoma

ZAIN UL ABIDEEN
ROLL NO. 41

Learning Objectives
Definition
Types
Pathophysiology
Diagnosis
Treatment

Definition
Glaucoma that develops secondary to any pathology

of crystalline Lens.
Can be:

Secondary Open-Angle Glaucoma

2. Secondary Angle-Closure Glaucoma
1.

Types
Phacomorphic Glaucoma
Phacolytic Glaucoma
Phacoantigenic Glaucoma

Phaco-Morphic Glaucoma
Its a secondary angle-closure glaucoma due to

lens intumescence.
The increase in lens thickness from an advanced
cataract, a rapidly intumescent lens, or a traumatic
cataract can lead to pupillary block and angle
closure.

Patho-Physiology :

The Swollen Cataractous Lens during, its

Immature/Mature stage may push against the back
of Iris and cause relative pupilary block.
This causes accumulation of aqueous in posterior
chamber, which pushes the flexible Iris in forward
direction that causes closure of Anterior Chamber
Angle. This Results in Rise of IOP.

Sypmtoms:

Acute pain, Blurred vision, Rainbow-colored halos

around lights, Nausea, and Vomiting.
Signs:
High intraocular pressure (IOP) - Greater than 35
mm Hg
Middilated, sluggish, irregular pupil
Corneal edema
Injection of conjunctival and episcleral vessels
Shallow central anterior chamber (AC)
Lens enlargement and forward displacement
Unequal cataract formation between the 2 eyes

Treatment:

Beta-blockers, alpha 2-adrenergic agonists,

prostaglandin analogs and carbonic anhydrase
inhibitors.
2. Laser iridotomy to relieve the pupillary block.
3. Lens Extraction is the ultimate treatment option.
1.

Phaco-Lytic Glaucoma
Phacolytic glaucoma (PG) is the sudden onset of

open-angle glaucoma caused by a leaking mature

or hypermature (rarely immature) cataract.
Pathophysioloy:

In hypermature cataract Lens protein leak through the

intact capsule into the aqueous. The macrophages
phagocytose these Lens Proteins. The Trabecular
meshwork is blocked by both the lens proteins and
macrophages.

Sypmtoms:
History of slow vision loss for months or years prior to
the acute onset of pain, redness, and sometimes
further decrease in vision.
Signs:
Raised IOP
Corneal edema
The anterior chamber contains Intense flare, Large

cells (macrophages) and Aggregates of white material,

Treatment:

Initial treatment of phacolytic glaucoma is focused upon

acute lowering of IOP using a combination of topical and

systemic IOP-lowering agents.
Topical steroids also may facilitate IOP lowering and
decrease pain.
The definitive treatment of phacolytic glaucoma (PG) is
cataract extraction:
Extracapsular cataract extraction (eg.
phacoemulsification) is prefferd treatment.
PG is caused by a lens that has dislocated into the vitreous
cavity, the procedure of choice is pars plana vitrectomy.

Phaco-antigenic Glaucoma
Phacoanaphylaxis/lens-induced uveitis occurs in the setting

of a ruptured or degenerative lens capsule and is

characterized by a granulomatous antigenic reaction to lens
protein.
Pathophysiology:
Trauma causes tear in the Lens capsule that results into the
Imbibition of water and Cataract formation. At the same time
lens proteins are also released which acts as Antigen and
produce antibodies.
The antigen-antibody reaction occurs on the surface of Iris,
Cilliary body and Lens, this lens induced uveitis may cause
Secodnary Glaucoma = Inflammatory Glaucoma

Symptoms:

Severe light sensitivity

Epiphora
Pain,
Floaters,
Decreased vision
Redness of the eye
Signs:
Important clinical signs of lens-induced Uveitis are Corneal
haze, Keratic, Cells and Flare, Fibrin in AC , Peripheral
Anterior Synechiae, Posterior Synechiae.

Treatment:
Corticosteroids
NSAIDS
IOP lowering Drugs : B-Blockers, Carbonic
Anhydrase Inhibitors, Alpha-Agonists.
If Medical treatment fails, Surgical Removal of Lens
Material is Planed.

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