eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Phacomorphic

Author: Harpreet Gill, MD, Staff Physician, Henry Ford Ophthalmology
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; Anju Gupta Goyal, MD, Assistant Professor of Ophthalmology, Kresge Eye Institute, Wayne State University; Director of Resident's Clinic, Kresge Eye Institute
Contributor Information and Disclosures

Updated: Jan 7, 2008

Introduction

Background

Phacomorphic glaucoma is the term used for 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.

Pathophysiology

In an eye with advanced cataract formation, the lens is swollen or intumescent. Progressive reduction occurs in the iridocorneal angle. In such eyes, pupillary block glaucoma is caused by changes in the size of the lens and the position of the anterior lens surface. Angle closure may be secondary to an enhanced pupillary block mechanism, or it may be due to forward displacement of the lens-iris diaphragm.

Frequency

International

Although no formal epidemiologic statistics are available, angle closure from hypermature cataracts is more common in countries where cataracts are common and surgery is not readily available.

Race

Phacomorphic glaucoma can occur in any race.

Sex

Phacomorphic glaucoma occurs equally in men and women.

Age

Generally, phacomorphic glaucoma is observed in older patients with senile cataracts, but it can occur in younger patients after a traumatic cataract or a rapidly developing intumescent cataract.

Clinical

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.

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

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.

More on Glaucoma, Phacomorphic

Overview: Glaucoma, Phacomorphic
Differential Diagnoses & Workup: Glaucoma, Phacomorphic
Treatment & Medication: Glaucoma, Phacomorphic
Follow-up: Glaucoma, Phacomorphic
Multimedia: Glaucoma, Phacomorphic
References
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References

  1. 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].

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

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

  4. 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].

  5. 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].

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

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

  8. Shields MB. Textbook of Glaucoma. 1998.

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

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Further Reading

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Keywords

phacomorphic glaucoma, lens intumescence, lens-induced angle-closure glaucoma, cataract, pupillary block glaucoma, senile cataracts

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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 Gupta Goyal, MD, Assistant Professor of Ophthalmology, Kresge Eye Institute, Wayne State University; Director of Resident's Clinic, Kresge Eye Institute
Anju Gupta 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.

Medical Editor

Richard W Allinson, MD, Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center, Scott and White Clinic
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
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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