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:
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High intraocular pressure (IOP) - Greater than 35 mm Hg
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Middilated, sluggish, irregular pupil
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Corneal edema
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Injection of conjunctival and episcleral vessels
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Shallow central anterior chamber (AC)
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Lens enlargement and forward displacement
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Unequal cataract formation between the 2 eyes
Causes
Certain factors predispose a patient to phacomorphic glaucoma, as follows:
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Intumescent cataract
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Traumatic cataract
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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.
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Phacomorphic glaucoma.
