Phacomorphic Glaucoma Clinical Presentation

  • Author: Harpreet Gill, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 25, 2012
 

History

  • Patients with phacomorphic glaucoma complain of acute pain, blurred vision, rainbow-colored halos around lights, nausea, and vomiting.
  • Patients generally have decreased vision before the acute episode because of a history of a cataract.
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Physical

Signs of phacomorphic glaucoma include the following:

  • 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
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Causes

  • Certain factors predispose a patient to phacomorphic glaucoma, as follows:
    • Intumescent cataract
    • Traumatic cataract
    • Rapidly developing senile cataract
  • Phacomorphic glaucoma is more common in smaller hyperopic eyes with a larger lens and a shallower AC.
  • An angle-closure attack can be precipitated by pupillary dilation in dim light. The dilation to midposition relaxes the peripheral iris so that it may bow forward, coming into contact with the trabecular meshwork, setting the stage for pupillary block. Angle closure also is facilitated by the pressure originating posterior to the lens and the enlargement of the lens itself.
  • Zonular weakness secondary to exfoliation, trauma, or age can play a part in causing phacomorphic glaucoma.
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Contributor Information and Disclosures
Author

Harpreet Gill, MD  Staff Physician, Henry Ford Ophthalmology

Harpreet Gill, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Mark S Juzych, MD, MHSA  Chief, Department of Ophthalmology, Harper Hospital; Associate Chair and Program Director, Associate Professor, Department of Ophthalmology, Kresge Eye Institute, Wayne State University School of Medicine

Mark S Juzych, MD, MHSA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, Association for Research in Vision and Ophthalmology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Anju Goyal, MD  Assistant Professor of Ophthalmology, Director of Residents' Clinic, Kresge Eye Institute, Wayne State University School of Medicine

Anju Goyal, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, and Michigan State Medical Society

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. Tham CC, Lai JS, Poon AS, Chan JC, Lam SW, Chua JK, et al. Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study. Eye (Lond). Jul 2005;19(7):778-83. [Medline].

  2. Leung CK, Chan WM, Ko CY, Chui SI, Woo J, Tsang MK, et al. Visualization of anterior chamber angle dynamics using optical coherence tomography. Ophthalmology. Jun 2005;112(6):980-4. [Medline].

  3. Dada T, Kumar S, Gadia R, Aggarwal A, Gupta V, Sihota R. Sutureless single-port transconjunctival pars plana limited vitrectomy combined with phacoemulsification for management of phacomorphic glaucoma. J Cataract Refract Surg. Jun 2007;33(6):951-4. [Medline].

  4. Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology. Vol 3. 1994.

  5. Duane TD, Jaeger EA. Clinical Ophthalmology. Vol 3. 1986.

  6. McKibbin M, Gupta A, Atkins AD. Cataract extraction and intraocular lens implantation in eyes with phacomorphic or phacolytic glaucoma. J Cataract Refract Surg. Jun 1996;22(5):633-6. [Medline].

  7. Rao SK, Padmanabhan P. Capsulorhexis in white cataracts. J Cataract Refract Surg. Apr 2000;26(4):477-8. [Medline].

  8. Ritch R, Shields MB, Krupin T. The Glaucomas. Vol 2. 1996.

  9. Shields MB. Textbook of Glaucoma. 1998.

  10. Vander JF, Gault JA. Ophthalmology Secrets. 1998.

 
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