eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Lens-Particle

Author: Brian R Sullivan, MD, Associate Professor, Department of Ophthalmology, University of Texas Southwestern Medical Center
Contributor Information and Disclosures

Updated: Jan 28, 2009

Introduction

Background

Lens-particle glaucoma, a subclassification of lens-induced glaucoma,1,2,3,4,5 is a type of secondary open-angle glaucoma involving intraocular retention of fragmented lens debris. Following surgery or injury, lens material may be sequestered within the capsular bag or dislocated into other areas of either the posterior eye or the anterior eye. Characteristically, large lens pieces spontaneously fragment further into small (sometimes invisible) particles that eventually migrate into the anterior chamber and obstruct aqueous outflow.6 Lens-particle glaucoma is not associated with decentration or dislocation of an intact lens.

Pathophysiology

The mechanism involves the following 4 processes: (1) presence of a nonintact lens capsule, usually violated during trauma or intraocular surgery; (2) dislocation of lens fragments into the anterior or posterior segment, with subsequent release of lens particles into the anterior chamber; (3) obstruction of trabecular meshwork by lens debris6 and inflammatory components7 ; and (4) reduction of the outflow facility of an open anterior chamber angle, resulting in elevation of intraocular pressure (IOP).

Frequency

United States

The incidence of lens-particle glaucoma has not been specifically reported.  The frequency of penetrating eye injury in the United States has been estimated at 3.1 per 100,000 person-years,8 with a predominance of young males.

Mortality/Morbidity

Mortality is not associated with this condition. Morbidity is rare.

Race

No known racial predilection exists.

Sex

No known gender predilection exists for lens-particle glaucoma. However, penetrating eye trauma, a risk factor for lens-particle glaucoma, has been reported to occur more commonly in young adult males.8 Alcohol abuse is a significant comorbidity in this population.

Age

All ages are affected, ranging from infancy (especially when involving congenital cataract surgery) to late adulthood. Penetrating eye injuries occur most frequently in young adults. However, lens-particle glaucoma probably occurs most commonly in elderly persons as a complication of cataract surgery.

Clinical

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, a recent or remote history of trauma or intraocular surgery2,9 particularly cataract extraction, typically is present.
  • The onset of lens-particle glaucoma has been reported to occur many years after cataract surgery10,11
    • 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 capsulotomy12 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 glaucoma13

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.
  • In cases of glaucoma with severe associated phacoantigenic uveitis, other late findings may include posterior synechia, peripheral anterior synechia, vitreitis, and retinal detachment.

Causes

  • Penetrating eye trauma with perforation of the lens capsule
  • Blunt trauma with rupture of the lens capsule14 or dislocation of a nonintact lens
  • 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

More on Glaucoma, Lens-Particle

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Multimedia: Glaucoma, Lens-Particle
References
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References

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  4. Serle JB. Nontraumatic lens-induced glaucoma. In: Higginbotham ET, Lee DA. Management of Difficult Glaucoma. Boston, MA: 1994:263-73.

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Further Reading

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Keywords

lens-particle glaucoma, lens particle glaucoma, vision loss, visual deficit, lens-induced glaucoma, open-angle glaucoma, open angle glaucoma, cataract surgery, cataract surgery complications, eye trauma, eye trauma complications, pars plana lensectomy, vitreolensectomy, nucleus dislocation, intravitreal lens, intravitreal nucleus, vitreous lens fragment, intravitreal lens fragment, phacoemulsification complication, phaco complication, phacoantigenic uveitis, phacoanaphylactic uveitis

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Contributor Information and Disclosures

Author

Brian R Sullivan, MD, Associate 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.

Medical Editor

Richard W Allinson, MD, Associate Professor, Department of Surgery, 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.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

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: Alcon Labs Salary Employment

CME Editor

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.

 
 
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