Ectopia Lentis Treatment & Management

Updated: Jun 06, 2018
  • Author: Charles W Eifrig, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

Medical Care

Without an antecedent history of trauma, patients with ectopia lentis may possess a systemic disease with potentially deleterious effects; therefore, comanagement with the patient's pediatrician or internist is essential. Dietary restriction may be partially effective in patients with homocystinuria. Repair of an impending dissecting aortic aneurysm in Marfan syndrome may be life saving. If a hereditary condition is discovered, appropriate genetic counseling should be given. Moreover, all relatives with potential risk should be examined.

Treatment of glaucoma is dependent on the etiologic mechanism.

In pupillary block (eg, patients who have Weil-Marchesani with microspherophakia), laser peripheral iridotomy or iridectomy should be performed, and intraocular pressure elevation should be treated medically. Prophylactic laser iridotomy in patients with microspherophakia is beneficial.

Treatment of a lens dislodged into the anterior chamber is initially pharmacological with mydriasis/cycloplegia (to permit posterior migration of the lens behind the iris) in conjunction with ocular massage through a closed lid to promote this posterior migration. Surgical treatment will then be needed to prevent further complications.

Treatment of a dislocated lens in the vitreous is surgical; however, many vitreoretinal surgeons may advocate observation if no visual disturbance or impending retinal complication is apparent.

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Surgical Care

Lens surgery in ectopia lentis is technically challenging, and the numerous techniques and strategies are beyond the scope of this article. [12]

Indications for lensectomy include the following:

  • Lens in the anterior chamber

  • Lens-induced uveitis

  • Lens-induced glaucoma

  • Lenticular opacity with poor visual function

  • Anisometropia or refractive error not amenable to optical correction (eg, in a child to prevent amblyopia)

  • Impending dislocation of the lens

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Prevention

Early diagnosis of ectopia lentis with appropriate optical correction can prevent amblyopia.

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Long-Term Monitoring

Close follow-up care with a full ocular examination, including tonometry (intraocular pressure check) and dilated fundus examination, is important.

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Inpatient & Outpatient Medications

Topical drops may be necessary to lower the intraocular pressure or to help decrease inflammation.

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