Phacolytic Glaucoma Clinical Presentation

  • Author: Kayoung Yi, MD, PhD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jul 6, 2011
 

History

  • Patients with phacolytic glaucoma typically have a history of slow vision loss for months or years prior to the acute onset of pain, redness, and sometimes further decrease in vision.[6]
  • Vision may only be inaccurate light perception due to the density of the cataract.
  • Symptoms mimic acute angle-closure glaucoma (see Glaucoma, Angle Closure, Acute).
  • The history of slow vision loss due to advancing cataract preceding the acute onset of symptoms is a vital clue to the correct diagnosis.
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Physical

  • Intraocular pressure (IOP) characteristically is elevated severely in phacolytic glaucoma.[7]
  • Slit lamp examination of phacolytic glaucoma typically reveals microcystic corneal edema, and the anterior chamber contains intense flare, large cells (macrophages), aggregates of white material, and iridescent or hyperrefringent particles. The latter represent calcium oxalate and cholesterol crystals being liberated from the degenerating cataractous lens. Unlike uveitic glaucoma (such as that seen in phacoanaphylactic glaucoma), no keratic precipitates typically are present.[8]
  • The anterior capsule of the lens frequently is dotted with patches of soft white material. In contrast to some forms of lens-induced glaucomas (eg, lens particle glaucoma, phacoanaphylactic glaucoma), the lens capsule is grossly intact.
  • Gonioscopy findings usually are normal; however, evidence of old angle recession was found in 25% of eyes in one study.
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Causes

  • Mature cataract (totally opacified)
  • Hypermature cataract (liquid cortex and free-floating nucleus)
  • Focal liquefaction of immature cataract (rare)
  • Dislocated cataractous lens in vitreous[9]
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Contributor Information and Disclosures
Author

Kayoung Yi, MD, PhD  Associate Professor, Department of Ophthalmology, Hallym University, Kangnam Sacred Heart Hospital, Korea

Kayoung Yi, MD, PhD is a member of the following medical societies: American Society of Cataract and Refractive Surgery and Korean Board of Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Teresa C Chen, MD, FACS  Assistant Professor, Department of Ophthalmology, Harvard Medical School; Director of Clinical Affairs, Glaucoma Service, Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Teresa C Chen, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, and Women in Ophthalmology, Inc

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

References

  1. Kanski JJ. Lens-related glaucoma. In: Clinical Ophthalmology. 5th ed. 2003:239.

  2. Richter C. Lens-induced open angle glaucoma: phacolytic glaucoma (lens protein glaucoma). In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas. 2nd ed. St Louis: Mosby; 1996:1023-1026.

  3. Stamper R, Lieberman M, Drake M. Secondary open-angle glaucoma: phacolytic glaucoma. In: Becker-Shaffer's Diagnosis and Therapy of the Glaucomas. 7th ed. St Louis, Mo: Mosby; 1999:324-326.

  4. Kim IT, Jung BY, Shim JY. Cholesterol crystals in aqueous humor of the eye with phacolytic glaucoma. J Korean Ophthalmol Soc. Sept 2000;41(9):2003-7.

  5. Mavrakanas N, Axmann S, Issum CV, Schutz JS, Shaarawy T. Phacolytic Glaucoma: Are There 2 Forms?. J Glaucoma. Mar 16 2011;[Medline].

  6. Pradhan D, Hennig A, Kumar J. A prospective study of 413 cases of lens-induced glaucoma in Nepal. Indian J Ophthalmol. 2001;Jun;49(2):103-7. [Medline].

  7. Mandal AK, Gothwal VK. Intraocular pressure control and visual outcome in patients with phacolytic glaucoma managed by extracapsular cataract extraction with or without posterior chamber intraocular lens implantation. Ophthalmic Surg Lasers. Nov 1998;29(11):880-9. [Medline].

  8. Allingham RR, Damji KD, Freedman S. Glaucomas associated with disorders of the lens: phacolytic (lens protein) glaucoma. In: Shields Textbook of Glaucoma. 2005. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 262-3.

  9. Chu ER, Durkin SR, Keembiyage RD, Nathan F, Raymond G. Nineteen-year delayed-onset phacolytic uveitis following dislocation of the crystalline lens. Can J Ophthalmol. Feb 2009;44(1):112. [Medline].

  10. Gadia R, Sihota R, Dada T, Gupta V. Current profile of secondary glaucomas. Indian J Ophthalmol. Jul-Aug 2008;56(4):285-9. [Medline].

  11. Sihota R, Kumar S, Gupta V, Dada T, Kashyap S, Insan R, et al. Early predictors of traumatic glaucoma after closed globe injury: trabecular pigmentation, widened angle recess, and higher baseline intraocular pressure. Arch Ophthalmol. Jul 2008;126(7):921-6. [Medline].

  12. Alliman KJ, Smiddy WE, Banta J, Qureshi Y, Miller DM, Schiffman JC. Ocular trauma and visual outcome secondary to paintball projectiles. Am J Ophthalmol. Feb 2009;147(2):239-242.e1. [Medline].

  13. Braganza A, Thomas R, George T. Management of phacolytic glaucoma: experience of 135 cases. Indian J Ophthalmol. Sep 1998;46(3):139-43. [Medline].

  14. Chen TC. Lens-induced glaucomas: surgical techniques and complications. Middle East J Ophthalmol. May 2004;12(1):40-52.

  15. Venkatesh R, Tan CS, Kumar TT, Ravindran RD. Safety and efficacy of manual small incision cataract surgery for phacolytic glaucoma. Br J Ophthalmol. Mar 2007;91(3):279-81. [Medline]. [Full Text].

  16. Alm A, Grierson I, Shields MB. Side effects associated with prostaglandin analog therapy. Surv Ophthalmol. Nov 2008;53 Suppl1:S93-105. [Medline].

 
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Microscopy of the aspirate at the time of cataract extraction shows clumped, notched rectangular platelike crystals from the aqueous of a patient with phacolytic glaucoma (X160). Reproduced from J Korean Ophthalmol Soc 2000 Sep;41(9): Copyright © 2000, Korean Ophthalmological Society. All rights reserved.
Microscopy of the aspirate at the time of cataract extraction of a patient with phacolytic glaucoma shows round, regular cells with foamy cytoplasm consistent with macrophages (*). A leukocyte (white arrow) and an erythrocyte (black arrow) also are seen (X160). Reproduced from J Korean Ophthalmol Soc 2000 Sep;41(9): Copyright © 2000, Korean Ophthalmological Society. All rights reserved.
 
 
 
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