Lens-Particle Glaucoma Clinical Presentation

Updated: Aug 13, 2015
  • Author: Brian R Sullivan, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

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, [9, 10, 11, 12] there is typically a recent or remote history of trauma or intraocular surgery, [2, 13, 14] particularly cataract extraction.

The onset of lens-particle glaucoma has been reported to occur many years after cataract surgery [15, 16] or penetrating trauma. [17]

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 capsulotomy. [18] 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 glaucoma. [19]

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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. A dislocated lens nucleus is shown in the image below.

Lens nucleus dislocated into the inferior vitreous Lens nucleus dislocated into the inferior vitreous during cataract surgery. Reprinted from Survey of Ophthalmology, Vol 43. Monshizadeh R, Nasrollah S, Haimovici R: Management of retained intravitreal lens fragments after cataract surgery. 397-403. Copyright 1999, with permission from Elsevier Science.

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

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Causes

See the list below:

  • Penetrating eye trauma with perforation of the lens capsule
  • Blunt trauma with rupture of the lens capsule [20] or dislocation of a nonintact lens (a ruptured lens capsule is shown in the image below)
    Ruptured lens capsule with elevated intraocular pr Ruptured lens capsule with elevated intraocular pressure following trauma. Courtesy of KS Kooner, MD.
  • Uncomplicated cataract surgery
  • Cataract surgery with incomplete removal of the lens cortex
  • Cataract surgery complicated by posterior dislocation of the nucleus or nuclear fragments
  • Pars plana vitrectomy or other intraocular surgery involving intentional or inadvertent compromise of the lens capsule's integrity [14]
  • Atraumatic lens particle glaucoma has been reported in cases of spontaneous anterior capsular dehiscence [9, 10] and in a case of Marfan syndrome with complete lens dislocation. [12]
  • Congenital cataract with persistent fetal vasculature (PVF) was a reported cause of spontaneous lens particle glaucoma in a 4-year-old child. [11]
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