Lens-Particle Glaucoma Workup

Updated: Jun 10, 2020
  • Author: Brian R Sullivan, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Workup

Laboratory Studies

Consider ruling out endophthalmitis via anterior chamber tap and vitreous tap with smears for Gram and Giemsa stains and cultures with antimicrobial sensitivities.

Culture media should include blood agar, Sabouraud media, chocolate agar, and thioglycolate broth.

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Imaging Studies

In cases of ocular trauma, a 20-MHz ultrasound probe [23] and a 35-MHz ultrasound probe [24] have been reported to help facilitate the visualization of the posterior capsule's integrity. The effective use of 50-MHz ultrasound biomicroscopy has been described in the assessment of occult zonular defects in traumatic cataracts. [25]

B-scan ultrasonography may be useful in localizing and measuring posteriorly displaced lens debris, particularly large nucleus fragments.

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Procedures

Anterior chamber tap and vitreous tap if endophthalmitis is suspected

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Histologic Findings

If anterior chamber paracentesis is performed, histology may demonstrate foamy macrophages [10] and lens particles.

A coexisting phacoantigenic uveitis often exists, and the lens histology may include the classic finding of zones of granulomatous and nongranulomatous inflammation that surround degenerating lens material. Inflammatory intraocular spindle cell mass simulating a neoplasm has been reported in lens-induced uveitis, [21] with a histologic finding of a large tumefaction of histiocytes and myofibroblasts.

Anterior chamber angle histologic examination of enucleated eyes may confirm the presence of macrophages in the trabecular meshwork, perhaps contributing to decreased outflow facility.

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