Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Phacoanaphylaxis Differential Diagnoses

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jun 14, 2016
 
 

Diagnostic Considerations

Phacoanaphylactic endophthalmitis or lens-induced uveitis may be difficult or impossible to distinguish from other causes of inflammation based on any one clinical sign, but the clinical setting of retained lens material after cataract surgery usually permits the ophthalmologist to make the correct diagnosis. Similarly, rupture of the lens capsule following trauma also points to a lens-induced inflammation. If the eye is injured severely, requiring enucleation, the presence of phacoanaphylaxis often is masked. According to a study by Thatch and Marak, from 144 histologically verified cases of phacoanaphylactic endophthalmitis, in only 6 cases was the diagnosis correct clinically before enucleation.[29]

Posttraumatic endophthalmitis

Endophthalmitis occurs following 2-7% of penetrating injuries. The incidence is higher in association with intraocular foreign bodies, particularly vegetable matter, while the incidence is lower with hot metallic projectiles. Posttraumatic endophthalmitis can progress rapidly. Clinical signs often include marked inflammation with fibrin, hypopyon, and retinal phlebitis. In general, the larger and more contaminated the injury, the more likely endophthalmitis will develop. Anterior chamber tap and vitreous tap should be performed, and intravitreal antibiotic injections should be administered.[43, 44]

Sterile (aseptic) endophthalmitis

Postoperative inflammation occurring in the absence of infection may be acute or chronic and mild to moderately severe.[45] The onset of aseptic endophthalmitis is usually 3-4 days after surgery. Exceptionally, sterile endophthalmitis may occur weeks or months after intraocular surgery, as with late rupture of the anterior hyaloid membrane and vitreous adhesion to the wound in aphakic patients, degradation of implant materials, withdrawal of topical steroid therapy, or dislocation of an intraocular lens (IOL).[46, 47, 48] It can present with hypopyon and cloudy vitreous, but usually no corneal edema, chemosis, or lid swelling is present. Unlike bacterial infections, aseptic endophthalmitis is not severely and progressively painful. Secondary aseptic endophthalmitis often is related to toxic foreign materials inoculated or implanted into the eye at the time of intraocular surgery.

Sympathetic ophthalmia

Clinically, sympathetic ophthalmia presents as a rare bilateral uveitis with an insidious onset and a progressive course.[49, 50, 51, 52, 53, 54, 55] It almost invariably follows a penetrating wound involving uveal tissue produced by either ocular trauma or intraocular surgery. Sympathetic ophthalmia also may occur with laser ciliary ablation procedures, particularly direct contact lasers. Involvement of the noninjured (nonoperated) eye in this disease makes the clinical diagnosis somewhat more straightforward.

The interesting association between phacoanaphylactic endophthalmitis and sympathetic ophthalmia is based upon histopathologic studies. Easom and Zimmerman reviewed 400 cases of sympathetic ophthalmia from the Armed Forces Institute of Pathology and found 7 pairs of eyes with sympathetic ophthalmia.[56, 57] Among them, 2 of the 7 inciting eyes and 6 of the 7 sympathizing eyes demonstrated the classic histopathologic appearance of phacoanaphylactic endophthalmitis instead of sympathetic ophthalmia.

The association of phacoanaphylactic endophthalmitis in sympathetic ophthalmia may be caused by secondary alteration of the lens capsule in sympathetic ophthalmia, or the 2 diseases may be synergistic. One differentiating feature may be the choroidal thickening observed in sympathetic ophthalmia on ultrasound because only minimal choroidal inflammation and thickening occur, even in severe forms of phacoanaphylactic endophthalmitis.[58]

Phacolytic glaucoma

The leakage of lens proteins from mature and hypermature cataracts characterize phacolytic glaucoma.[59, 27, 60, 61, 62] This leakage often is associated with pain, light sensitivity, and marked anterior chamber reaction. The trabecular meshwork becomes blocked by macrophages and high molecular weight proteins, and then increased intraocular pressure develops. Definitive treatment requires cataract surgery.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

R Christopher Walton, MD Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, University of Tennessee College of Medicine

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Retina Society, American College of Healthcare Executives, American Uveitis Society

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Acknowledgements

Charles C Barr, MD Retina Service Director, Professor, Department of Ophthalmology, University of Louisville School of Medicine

Disclosure: Nothing to disclose.

Judith Mohay, MD Director of Primary Care Center Eye Clinic, Instructor, Department of Ophthalmology, University of Louisville School of Medicine

Disclosure: Nothing to disclose.

References
  1. Bloch-Michel E, Nussenblatt RB. International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease. Am J Ophthalmol. 1987 Feb 15. 103(2):234-5. [Medline].

  2. Brinkman CJ, Broekhuyse RM. Cell mediated immunity in relation to cataract and cataract surgery. Br J Ophthalmol. 1979 May. 63(5):301-5. [Medline].

  3. Luntz MH, Wright R. Lens-induced uveitis. Exp Eye Res. 1962. 1:317-323.

  4. Zimmerman LE. Lens induced inflammation in human eyes. Maumenee AE, Silverstein AM, eds. Immunopathology of Uveitis. Lippincott Williams & Wilkins; 1964. 221-232.

  5. Sheppard JD, Nozik RA. Clinical Ophthalmology. Duane TA, Jaeger EW eds. Practical Diagnostic Approach to Uveitis. Philadelphia: JB Lippincott; 1989. 4, chapter 33:

  6. Verhoeff FH, Lemoine AN. Endophthalmitis phacoanaphylactica. Am J Ophthalmol. 1922. 5:737-745.

  7. Apple DJ, Mamalis N, Steinmetz RL, Loftfield K, Crandall AS, Olson RJ. Phacoanaphylactic endophthalmitis associated with extracapsular cataract extraction and posterior chamber intraocular lens. Arch Ophthalmol. 1984 Oct. 102(10):1528-32. [Medline].

  8. Blodi BA, Flynn HW Jr, Blodi CF, Folk JC, Daily MJ. Retained nuclei after cataract surgery. Ophthalmology. 1992 Jan. 99(1):41-4. [Medline].

  9. Bai HQ, Yao L, Wang DB, Jin R, Wang YX. Causes and treatments of traumatic secondary glaucoma. Eur J Ophthalmol. 2009 Mar-Apr. 19(2):201-6. [Medline].

  10. Emery JM, Wilhelmus KA, Rosenberg S. Complications of phacoemulsification. Ophthalmology. 1978 Feb. 85(2):141-50. [Medline].

  11. Fine HI. Small incision cataract surgery. Yanoff M, Duker JS. Ophthalmology. 1st ed. Mosby Inc; 1999. 23.1-10.

  12. Gifford SR. Allergic and toxic properties of lens protein. JAMA. 1925. 85:351-356.

  13. Goodner EK. Experimental lens-induced uveitis in rabbits. Maumenee AE, Silverstein AM, ed. Immunopathology of Uveitis. Lippincott Williams & Wilkins; 1964. 233-242.

  14. Hektoen L, Schulhof K. Further observations on lens precipitins. Antigenic properties of alpha and beta crystallins. J Infect Dis. 1924. 34:433-439.

  15. Little J, Langman J. Lens antigens in the intraocular tissues of the human eye. Arch Ophthal. 1964. 72:820-825.

  16. Mehta PD, Cooper SN, Rao SS. Identification of species -specific and organ-specific antigens in lens proteins. Exp Eye Res. 1964. 3:192-199.

  17. Kida H. Experimental endophthalmitis phacoanaphylactica in rabbits sensitized with the purified bovine alpha-crystallin. Folia Ophthalmol Jpn. 1961. 12:304-311.

  18. Rahi AH, Garner A. Immunopathology of the Eye. Oxford, England: Blackwell Scientific Publications; 1976.

  19. Woods AC. An adventure in ophthalmic literature: Manuel Straub and the tradition of toxicity in lens protein. Am J Ophthalmol. 1959. 48:463-472.

  20. Maisel H, Goodman M. Analysis of mammalian lens proteins by electrophoresis. Arch Ophthal. 1964. 71:671-675.

  21. Halbert SP, Manski W. Biological aspects of autoimmune reactions in the lens. Invest Ophthal. 1965. 4:516-530.

  22. Friedlander MH. Allergy and Immunology of the Eye. Lippincott-Raven Publishers; 1979. 24-203.

  23. Kincses E, Szabo G. Human and cellular immune response after injury of the lens . Ocular Immune Responses: Proceedings of the International Symposium on Immunology & Immunopathology of the Eye. Strasbourg: S Karger AG Basel Publisher; 1974. 16.

  24. Marak GE Jr. Phacoanaphylactic endophthalmitis. Surv Ophthalmol. 1992 Mar-Apr. 36(5):325-39. [Medline].

  25. Schubert HD. Postsurgical hypotony: relationship to fistulization, inflammation, chorioretinal lesions, and the vitreous. Surv Ophthalmol. 1996 Sep-Oct. 41(2):97-125. [Medline].

  26. Gass JD, Norton EW. Follow-up study of cystoid macular edema following cataract extraction. Trans Am Acad Ophthalmol Otolaryngol. 1969 Jul-Aug. 73(4):665-82. [Medline].

  27. Ellant JP, Obstbaum SA. Lens-induced glaucoma. Doc Ophthalmol. 1992. 81(3):317-38. [Medline].

  28. Toris CB, Pederson JE. Aqueous humor dynamics in experimental iridocyclitis. Invest Ophthalmol Vis Sci. 1987 Mar. 28(3):477-81. [Medline].

  29. Thach AB, Marak GE Jr, McLean IW, Green WR. Phacoanaphylactic endophthalmitis: a clinicopathologic review. Int Ophthalmol. 1991 Jul. 15(4):271-9. [Medline].

  30. Besen G, Freeman WR. Intraoperative recognition of retinal vasculitis in a patient with early lens-induced uveitis. Ophthalmic Surg Lasers. 1997 Jan. 28(1):67-8. [Medline].

  31. Chishti M, Henkind P. Spontaneous rupture of anterior lens capsule (phacoanaphylactic endophthalmitis). Am J Ophthalmol. 1970 Feb. 69(2):264-70. [Medline].

  32. Perlman EM, Albert DM. Clinically unsuspected phacoanaphylaxis after ocular trauma. Arch Ophthalmol. 1977 Feb. 95(2):244-6. [Medline].

  33. Perlman EM, Albert DM. Clinically unsuspected phacoanaphylaxis after ocular trauma. Arch Ophthalmol. 1977 Feb. 95(2):244-6. [Medline].

  34. Habil I, Cohen E, Karshai I, BenEzra D, Behar-Cohen F. Spontaneous involution of autologous lenses and phacoanaphylaxis reaction in Stickler syndrome. Br J Ophthalmol. 2005 Nov. 89(11):1532-3. [Medline].

  35. Inomata H, Yoshikawa H, Rao NA. Phacoanaphylaxis in Behçet's disease: a clinicopathologic and immunohistochemical study. Ophthalmology. 2003 Oct. 110(10):1942-5. [Medline].

  36. McCluskey P, Harrisberg B. Long-term results using scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 1994 Jan. 20(1):34-9. [Medline].

  37. McMahon MS, Weiss JS, Riedel KG. Clinically unsuspected phacoanaphylaxis after extracapsular cataract extraction with intraocular lens implantation. Br J Ophthalmol. 1985 Nov. 69(11):836-40. [Medline].

  38. Muccioli C, Belfort R Jr. Cataract surgery in patients with uveitis. Int Ophthalmol Clin. 2000 Spring. 40(2):163-73. [Medline].

  39. Truhlsen SM. Approaching nucleus slippage. Arch Ophthalmol. 1991 May. 109(5):627. [Medline].

  40. Habil I, Cohen E, Karshai I, BenEzra D, Behar-Cohen F. Spontaneous involution of autologous lenses and phacoanaphylaxis reaction in Stickler syndrome. Br J Ophthalmol. 2005 Nov. 89(11):1532-3. [Medline].

  41. Inomata H, Yoshikawa H, Rao NA. Phacoanaphylaxis in Behçet's disease: a clinicopathologic and immunohistochemical study. Ophthalmology. 2003 Oct. 110(10):1942-5. [Medline].

  42. Ritch R. Exfoliation syndrome and exfoliative glaucoma. Eid TM, Spaeth GL. Glaucomas: Concepts and Fundamentals. Lippincott Williams & Wilkins: 2000. 114-120.

  43. Thompson JT, Parver LM, Enger CL, Mieler WF, Liggett PE. Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System. Ophthalmology. 1993 Oct. 100(10):1468-74. [Medline].

  44. Winward KE, Pflugfelder SC, Flynn HW Jr, Roussel TJ, Davis JL. Postoperative Propionibacterium endophthalmitis. Treatment strategies and long-term results. Ophthalmology. 1993 Apr. 100(4):447-51. [Medline].

  45. Speaker MG, Smolin G, Menikoff JA, Friedlaender MH, eds. Postoperative endophthalmitis: Pathogenesis, prophylaxis and management. International Ophthalmology Clinics. 1993. Vol 33.: 51-70.

  46. Meltzer DW. Sterile hypopyon following intraocular lens surgery. Arch Ophthalmol. 1980 Jan. 98(1):100-4. [Medline].

  47. Kraff MC, Sanders DR, Lieberman HL, Peyman GA, Levine RA. Membrane formation after implantation of polyvinyl alcohol-coated intraocular lenses. J Am Intraocul Implant Soc. 1980 Apr. 6(2):129-36. [Medline].

  48. Stark WJ, Rosenblum P, Maumenee AE, Cowan CL. Postoperative inflammatory reactions to intraocular lense sterilized with ethylene-oxide. Ophthalmology. 1980 May. 87(5):385-9. [Medline].

  49. Allen JC. Sympathetic uveitis and phacoanaphylaxis. Am J Ophthalmol. 1967 Feb. 63(2):280-3. [Medline].

  50. Blodi FC. Sympathetic uveitis as an allergic phenomenon: with a study in association with phacoanaphylactic uveitis and a report on the pathological findings in sympathizing eyes. Trans Am Acad Ophthal Otolaryng. 1959. 63:642-649.

  51. Chan CC. Relationship between sympathetic ophthalmia, phacoanaphylatic endophthalmitis, and Vogt-Koyanagi-Harada disease. Ophthalmology. 1988 May. 95(5):619-24. [Medline].

  52. Sheppard JD. Seminars in Ophthalmology. Beatty RL, ed. Sympathetic Ophthalmia. Philadelphia: JB Lippincott; 1994.

  53. Ishikawa Y, Kawata K. Three cases of endophthalmitis phacoanaphylactica in the fellow eye after extracapsular lens extraction. Folia Ophthalmol Jpn. 1977. 28:1260-1265.

  54. Lubin JR, Albert DM, Weinstein M. Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases (1913--1978). Ophthalmology. 1980 Feb. 87(2):109-21. [Medline].

  55. Sisk RA, Davis JL, Dubovy SR, Smiddy WE. Sympathetic ophthalmia following vitrectomy for endophthalmitis after intravitreal bevacizumab. Ocul Immunol Inflamm. 2008 Sep-Oct. 16(5):236-8. [Medline].

  56. Easom H, Zimmerman LE. Sympathetic ophthalmia and bilateral phacoanaphylaxis. A clinicopathologic correlation of the sympathogenic and sympathizing eyes. Arch Ophthalmol. 1964 Jul. 72:9-15. [Medline].

  57. Easom HA, Zimmerman LE. Sympathetic ophthalmia and bilateral phacoanaphylaxis. A clinicopathological correlation of the sympathogenic and sympathizing eyes. Arch Ophthalmol. 1964. 72:9-15.

  58. Croxatto JO, Rao NA, McLean IW, Marak GE. Atypical histopathologic features in sympathetic ophthalmia. A study of a hundred cases. Int Ophthalmol. 1982 Feb. 4(3):129-35. [Medline].

  59. Muller H. Phacolytic glaucoma and phacogenic ophthalmia (lens-induced uveitis). Trans Ophthal. Soc. UK. 1963. 83:689-704.

  60. Epstein DL. Diagnosis and management of lens-induced glaucoma. Ophthalmology. 1982 Mar. 89(3):227-30. [Medline].

  61. Fisher D. Glaucoma associated with uveitis (Inflammatory glaucoma). Eid TM, Spaeth GL. The Glaucomas: Concepts and Fundamentals. Lippincott Williams & Wilkins; 2000. 190-198.

  62. Irvine SR, Irvine AR Jr. Lens-induced uveitis and glaucoma: Endophthalmitis phacoanaphylactica. Am J Ophthalmol. 1952. 35:177.

  63. Alward WL, Byrne SF, Hughes JR, Hodapp EA. Dislocated lens nuclei simulating choroidal melanomas. Arch Ophthalmol. 1989 Oct. 107(10):1463-4. [Medline].

  64. Pavlin CJ, Harasiewicz K, Sherar MD, Foster FS. Clinical use of ultrasound biomicroscopy. Ophthalmology. 1991 Mar. 98(3):287-95. [Medline].

  65. Sampaolesi R. Three-dimensional scan using a single transducer and image construction. Tomita M, Sugata Y, Yamamoto Y, eds. Ultrasonography in Ophthalmology 12, Documenta Ophthalmologica Proceedings. Kluwer Academic Publishers; 1990. 455-460.

  66. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Management of dislocated nuclear fragments after phacoemulsification. Am J Ophthalmol. 1991 Nov 15. 112(5):535-9. [Medline].

  67. Gilliland GD, Hutton WL, Fuller DG. Retained intravitreal lens fragments after cataract surgery. Ophthalmology. 1992 Aug. 99(8):1263-7; discussion 1268-9. [Medline].

  68. Kim JE, Flynn HW Jr, Smiddy WE, et al. Retained lens fragments after phacoemulsification. Ophthalmology. 1994 Nov. 101(11):1827-32. [Medline].

  69. Lambrou FH Jr, Stewart MW. Management of dislocated lens fragments during phacoemulsification. Ophthalmology. 1992 Aug. 99(8):1260-2; discussion 1268-9. [Medline].

  70. Smiddy WE, Flynn HW. Management of retained lens fragments and dislocated posterior chamber intraocular lenses. In: Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology. WB Saunders Co. 2000:2485-2494.

  71. Schaal S, Barr CC. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. J Cataract Refract Surg. 2009 May. 35(5):863-7. [Medline].

  72. Stewart MW. Managing retained lens fragments: raising the bar. Am J Ophthalmol. 2009 Apr. 147(4):569-70. [Medline].

  73. Ho LY, Doft BH, Wang L, Bunker CH. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. Am J Ophthalmol. 2009 Apr. 147(4):587-594.e1. [Medline].

  74. Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol. 1995 Dec. 113(12):1479-96. [Medline].

  75. Greve MD, Peyman GA, Mehta NJ, Millsap CM. Use of perfluoroperhydrophenanthrene in the management of posteriorly dislocated crystalline and intraocular lenses. Ophthalmic Surg. 1993 Sep. 24(9):593-7. [Medline].

  76. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. Ophthalmology. 1996 Jun. 103(6):971-6. [Medline].

  77. Schechter RJ. Glass-slide vitrectomy for use by the cataract surgeon. Am J Ophthalmol. 1991 Jul 15. 112(1):100. [Medline].

  78. Weinstein GW, Charlton JF, Esmer E. The "lost lens": a new surgical technique using the Machemer lens. Ophthalmic Surg. 1995 Mar-Apr. 26(2):156-9. [Medline].

  79. Vilar NF, Flynn HW Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. Ophthalmology. 1997 May. 104(5):787-91; discussion 791-2. [Medline].

  80. Jaffe NS. Cataract Surgery & Its Complications. St. Louis: Mosby Inc; 1976. 367-370.

  81. Aaberg TM Jr, Rubsamen PE, Flynn HW Jr, Chang S, Mieler WF, Smiddy WE. Giant retinal tear as a complication of attempted removal of intravitreal lens fragments during cataract surgery. Am J Ophthalmol. 1997 Aug. 124(2):222-6. [Medline].

  82. Bourke RD, Gray PJ, Rosen PH, Cooling RJ. Retinal detachment complicating scleral-sutured posterior chamber intraocular lens surgery. Eye. 1996. 10 (Pt 4):501-8. [Medline].

  83. Burky EL, Woods AC. Lens extract: its preparation and clinical use. Arch Ophthalmol. 1931. 6:548-553.

  84. Epstein E. Suture problems. J Cataract Refract Surg. 1989 Jan. 15(1):116. [Medline].

  85. Kronenthal RL. Nylon in the anterior chamber. Ophthalmology. 1981 Sep. 88(9):965-7. [Medline].

  86. Leaming DV. Practice styles and preferences of ASCRS members--1994 survey. J Cataract Refract Surg. 1995 Jul. 21(4):378-85. [Medline].

  87. Uhlenhuth P. Zur Lehre von der Unterscheidung verschiedener Eiweissarten mit Hilfe spezifischer Sera. In: Festschrift zum Geburstag Robert Koch. Gustav Fischer Verlag. 1903:49-74.

  88. Volcker HE, Naumann GO. Morphology of uveal and retinal edemas in acute and persisting hypotony. Mod Probl Ophthalmol. 1979. 20:34-41. [Medline].

 
Previous
Next
 
Gross photomicrograph for eye enucleated with penetrating injury.
Gross photomicrograph for eye enucleated with penetrating injury. Note marked inflammatory reaction consisting of polymorphonuclear cells around lens capsule and lens fibers (hematoxylin and eosin X100).
Low (X25) photomicrograph of phacoanaphylactic reaction to lens protein in eye enucleated with penetrating injury. Note polymorphonuclear leucocytes around lens protein (hematoxylin and eosin).
High (X50) photomicrograph of phacoanaphylactic reaction to lens protein in eye enucleated with penetrating injury. Note polymorphonuclear leucocytes around lens protein (hematoxylin and eosin).
Phacoanaphylactic reaction to penetrating injury of lens. This patient was a 25-year-old woman whose eye was penetrated with a 27-gauge needle during an attempt to anesthetize the eyelid for chalazion removal. One week later, a marked uveitis was present. Notice perforation site and posterior synechiae.
Same patient as in Media file 5. Notice cortical cataract at perforation site.
Typical clinical picture of retained lens material following cataract surgery. White cortical material is easily visible in the pupillary space.
Patient with persistently elevated intraocular pressure after cataract surgery was found to have retained lens material and low-grade inflammation. Eye is white and quiet with anterior chamber lens.
Patient with persistently elevated intraocular pressure after cataract surgery was found to have retained lens material and low-grade inflammation. Retained lens material is visible in retroillumination on downgaze.
Typical appearance of retained lens fragments in posterior vitreous cavity. Lens material is a whitish substance that obscures fundus details.
Another view of a retained lens fragment, noted inferiorly.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.