Lens related Glaucoma

Zain ul abideenRoll no. 41Lens related Glaucoma

Learning ObjectivesDefinitionTypesPathophysiologyDiagnosisTreatment

DefinitionGlaucoma that develops secondary to any pathology of crystalline Lens.

Can be:Secondary Open-Angle GlaucomaSecondary Angle-Closure GlaucomaTypesPhacomorphic GlaucomaPhacolytic GlaucomaPhacoantigenic Glaucoma Phaco-Morphic GlaucomaIts a secondary angle-closure glaucoma due to lens intumescence.The increase in lens thickness from an advanced cataract, a rapidly intumescent lens, or a traumatic cataract can lead to pupillary block and angle closure.Patho-Physiology :The Swollen Cataractous Lens during, its Immature/Mature stage may push against the back of Iris and cause relative pupilary block.This causes accumulation of aqueous in posterior chamber, which pushes the flexible Iris in forward direction that causes closure of Anterior Chamber Angle. This Results in Rise of IOP.

Sypmtoms:Acute pain, Blurred vision, Rainbow-colored halos around lights, Nausea, and Vomiting.Signs:High intraocular pressure (IOP) - Greater than 35 mm HgMiddilated, sluggish, irregular pupilCorneal edemaInjection of conjunctival and episcleral vesselsShallow central anterior chamber (AC)Lens enlargement and forward displacementUnequal cataract formation between the 2 eyes

Treatment:Beta-blockers, alpha 2-adrenergic agonists, prostaglandin analogs and carbonic anhydrase inhibitors.Laser iridotomy to relieve the pupillary block.Lens Extraction is the ultimate treatment option.

Phaco-Lytic GlaucomaPhacolytic glaucoma (PG) is the sudden onset of open-angle glaucoma caused by a leaking mature or hypermature (rarely immature)cataract.

Pathophysioloy:In hypermature cataract Lens protein leak through the intact capsule into the aqueous. The macrophages phagocytose these Lens Proteins. The Trabecular meshwork is blocked by both the lens proteins and macrophages.

Sypmtoms:History of slow vision loss for months or years prior to the acute onset of pain, redness, and sometimes further decrease in vision.Signs:Raised IOP Corneal edema

The anterior chamber contains Intense flare, Large cells (macrophages) and Aggregates of white material,

Treatment:

Initial treatment of phacolytic glaucoma is focused upon acute lowering of IOP using a combination of topical and systemic IOP-lowering agents.Topical steroids also may facilitate IOP lowering and decrease pain.The definitive treatment of phacolytic glaucoma (PG) is cataract extraction:Extracapsular cataract extraction (eg. phacoemulsification) is prefferd treatment.PG is caused by a lens that has dislocated into the vitreous cavity, the procedure of choice is pars plana vitrectomy.Phaco-antigenic GlaucomaPhacoanaphylaxis/lens-induced uveitis occurs in the setting of a ruptured or degenerative lens capsule and is characterized by a granulomatous antigenic reaction to lens protein.Pathophysiology: Trauma causes tear in the Lens capsule that results into the Imbibition of water and Cataract formation. At the same time lens proteins are also released which acts as Antigen and produce antibodies.The antigen-antibody reaction occurs on the surface of Iris, Cilliary body and Lens, this lens induced uveitis may cause Secodnary Glaucoma = Inflammatory GlaucomaSymptoms:Severe light sensitivityEpiphoraPain,Floaters,Decreased visionRedness of the eyeSigns:Important clinical signs of lens-induced Uveitis are Corneal haze, Keratic, Cells and Flare, Fibrin in AC , Peripheral Anterior Synechiae, Posterior Synechiae.Treatment:CorticosteroidsNSAIDSIOP lowering Drugs : B-Blockers, Carbonic Anhydrase Inhibitors, Alpha-Agonists.

If Medical treatment fails, Surgical Removal of Lens Material is Planed.

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