Lens-Particle Glaucoma Clinical Presentation

  • Author: Brian R Sullivan, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 16, 2012
 

History

  • Patients are often asymptomatic.
  • Depending on the severity of IOP elevation and associated intraocular inflammation, symptoms of monocular eye pain, redness, and/or blurred vision may be present.
  • Although spontaneous rupture of the lens capsule has been described,[9] a recent or remote history of trauma or intraocular surgery,[2, 10] particularly cataract extraction, typically is present.
  • The onset of lens-particle glaucoma has been reported to occur many years after cataract surgery[11, 12] or penetrating trauma.[13]
    • Lens-particle glaucoma is commonly encountered in cases of phacoemulsification that were complicated by a posteriorly dislocated lens nucleus.
    • Obstruction of the trabecular meshwork by lens material may have a role in the mechanism of an early postoperative IOP spike after uncomplicated phacoemulsification.
    • Lens-particle glaucoma also may cause elevated IOP after laser capsulotomy.[14] Obtain any history of YAG laser procedures in all pseudophakic patients under evaluation for glaucoma.
    • Dislocation of a posterior intraocular lens has been reported to cause late onset lens-particle glaucoma.[15]
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Physical

  • Unilateral elevation of IOP is present.
  • Variable degree of inflammation, including cell and flare, corneal edema, keratic precipitates, or hypopyon, may be present.
  • Lens debris, sometimes seen as a fluffy pseudohypopyon layered in the inferior anterior chamber or as small free-floating fragments of cortex that circulate in the aqueous, may be visible by slit lamp examination. Lens or cellular debris also may be deposited on the corneal endothelium.
  • Anterior chamber angle is open by gonioscopy, although inflammatory anterior synechia may be observed later in more severe cases.
  • Lens fragments may be visible on dilated slit lamp examination, adherent to the lens capsule.
  • Elschnig pearls may be observed in chronic cases of lens-particle glaucoma.
  • Particles of cortex or nucleus that are dislocated into the vitreous usually are visualized readily by indirect ophthalmoscopy. In such cases, careful scleral depression can aid in identifying occult lens particles that are positioned over the anterior retina or ora serrata. A dislocated lens nucleus is shown in the image below. Lens nucleus dislocated into the inferior vitreousLens nucleus dislocated into the inferior vitreous during cataract surgery. Reprinted from Survey of Ophthalmology, Vol 43. Monshizadeh R, Nasrollah S, Haimovici R: Management of retained intravitreal lens fragments after cataract surgery. 397-403. Copyright 1999, with permission from Elsevier Science.
  • In cases of glaucoma with severe associated phacoantigenic uveitis, other late findings may include posterior synechia, peripheral anterior synechia, vitreitis, and retinal detachment.
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Causes

  • Penetrating eye trauma with perforation of the lens capsule
  • Blunt trauma with rupture of the lens capsule[16] or dislocation of a nonintact lens (a ruptured lens capsule is shown in the image below) Ruptured lens capsule with elevated intraocular prRuptured lens capsule with elevated intraocular pressure following trauma. Courtesy of KS Kooner, MD.
  • Uncomplicated cataract surgery
  • Cataract surgery with incomplete removal of the lens cortex
  • Cataract surgery complicated by posterior dislocation of the nucleus or nuclear fragments
  • Other intraocular surgery involving intentional or inadvertent compromise of the lens capsule's integrity
  • Atraumatic lens particle glaucoma due to spontaneous anterior capsular dehiscence has been reported.[9]
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Contributor Information and Disclosures
Author

Brian R Sullivan, MD  Professor, Department of Ophthalmology, University of Texas Southwestern Medical Center

Brian R Sullivan, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard W Allinson, MD  Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD, is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Martin B Wax, MD  Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Supported in part by an unrestricted research grant from Research to Prevent Blindness, Inc, New York, New York.

At the time of writing and subsequently updating this article, the author had no financial interests in any of the products discussed herein, nor in any of the companies that manufacture or distribute them.

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Lens nucleus dislocated into the inferior vitreous during cataract surgery. Reprinted from Survey of Ophthalmology, Vol 43. Monshizadeh R, Nasrollah S, Haimovici R: Management of retained intravitreal lens fragments after cataract surgery. 397-403. Copyright 1999, with permission from Elsevier Science.
Ruptured lens capsule with elevated intraocular pressure following trauma. Courtesy of KS Kooner, MD.
 
 
 
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