History
Patients with phacolytic glaucoma typically have a history of slow vision loss for months or years prior to the acute onset of pain, redness, and sometimes further decrease in vision. [8]
Vision may only be inaccurate light perception due to the density of the cataract.
Symptoms mimic acute angle-closure glaucoma (see Glaucoma, Angle Closure, Acute).
The history of slow vision loss due to advancing cataract preceding the acute onset of symptoms is a vital clue to the correct diagnosis.
Physical
Intraocular pressure (IOP) characteristically is elevated severely in phacolytic glaucoma. [9]
Slit lamp examination of phacolytic glaucoma typically reveals microcystic corneal edema, and the anterior chamber contains intense flare, large cells (macrophages), aggregates of white material, and iridescent or hyperrefringent particles. The latter represent calcium oxalate and cholesterol crystals being liberated from the degenerating cataractous lens. Unlike uveitic glaucoma (such as that seen in phacoanaphylactic glaucoma), no keratic precipitates typically are present. [10]
The anterior capsule of the lens frequently is dotted with patches of soft white material. In contrast to some forms of lens-induced glaucomas (eg, lens particle glaucoma, phacoanaphylactic glaucoma), the lens capsule is grossly intact.
Gonioscopy findings usually are normal; however, evidence of old angle recession was found in 25% of eyes in one study.
Causes
Phacolytic glaucoma may be caused by the following:
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Mature cataract (totally opacified)
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Hypermature cataract (liquid cortex and free-floating nucleus)
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Focal liquefaction of immature cataract (rare)
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Dislocated cataractous lens in vitreous [11]
Complications
Potential complications of phacolytic glaucoma include the following:
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Loss of vision from uncontrolled glaucoma and/or persistent corneal edema
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Surgical complications, including suprachoroidal hemorrhage, capsular rupture with loss of lens material into the posterior segment, corneal injury, and vitreous prolapse
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Microscopy of the aspirate at the time of cataract extraction shows clumped, notched rectangular platelike crystals from the aqueous of a patient with phacolytic glaucoma (X160). Reproduced from J Korean Ophthalmol Soc 2000 Sep;41(9): Copyright © 2000, Korean Ophthalmological Society. All rights reserved.
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Microscopy of the aspirate at the time of cataract extraction of a patient with phacolytic glaucoma shows round, regular cells with foamy cytoplasm consistent with macrophages (*). A leukocyte (white arrow) and an erythrocyte (black arrow) also are seen (X160). Reproduced from J Korean Ophthalmol Soc 2000 Sep;41(9): Copyright © 2000, Korean Ophthalmological Society. All rights reserved.
