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General Information ⬇

Definition

Lens material liberated by trauma or surgery obstructs aqueous outflow channels.

Symptoms ⬆ ⬇

Pain, blurred vision, red eye, tearing, and photophobia. History of recent ocular trauma or intraocular surgery.

Signs ⬆ ⬇

Critical

White, fluffy pieces of lens cortical material in the anterior chamber, combined with increased IOP.

Other

Anterior chamber cell and flare, conjunctival injection, or corneal edema. The anterior chamber angle is open on gonioscopy.

Differential Diagnosis ⬆ ⬇

  • See 9.12.1, PHACOLYTIC GLAUCOMA. In phacolytic glaucoma, the lens capsule is intact.
  • Infectious endophthalmitis: Usually a normal or low IOP. Unless lens cortical material can be unequivocally identified in the anterior chamber, and there is nothing atypical about the presentation, endophthalmitis must be excluded. See 12.13, POSTOPERATIVE ENDOPHTHALMITIS and 12.15, TRAUMATIC ENDOPHTHALMITIS.
  • Phacoantigenic (formerly phacoanaphylaxis): Requires prior sensitization to lens material. Follows trauma or intraocular surgery, producing anterior chamber inflammation and sometimes a high IOP. The inflammation is often granulomatous, and fluffy lens material is not present in the anterior chamber. See 9.12.3, PHACOANTIGENIC (FORMERLY PHACOANAPHYLAXIS).

Work Up ⬆ ⬇

Workup

  1. History: Recent trauma or intraocular surgery?
  2. Slit lamp examination: Search the anterior chamber for lens cortical material and measure the IOP.
  3. Gonioscopy of the anterior chamber angle.
  4. Optic nerve evaluation: Degree of optic nerve cupping helps determine how long the increased IOP can be tolerated.

Treatment ⬆ ⬇

See 9.12.1, PHACOLYTIC GLAUCOMA, for medical treatment. If medical therapy fails to control the IOP, the residual lens material must be removed surgically.

Follow Up ⬆

Depending on the IOP and health of the optic nerve, patients are reexamined in 1 to 7 days.