Crystalline Lens (Secondary cataracts + Luxation)

Secondary cataracts

Complications of another ocular condition

Posterior subcapsular cataracts

Commonly seen with chronic anterior uveitis or myopic pts (over -5D)

Caused by long duration and severe inflammation, use of steroids contribute to development

Galukomflecken

Pathognomonic of acute angle closure glaucoma

Grey/white opacities in capsule or subcapsular, high IOP causes epi cells to becomes ischemic

Oral and topical steroids cause…

Posterior subcapsular cataracts

More common in oral (topical usually causes increase in IOP)

Chlorpromazine

Antipsychotic med, causes anterior star cataract

Trauma related secondary cataracts

Presentation depends on etiology

Blunt, electric shock, infrared radiation

Blunt trauma causes what type of secdonary cataract?

Sunflower cataract

Influx of aqueous into the lens from capsule rupture

Electric shock causes what type of secondary cataract?

Snowflake like cataract

Diffuse white opacities in snowflake configuration (looks like diabetic, ask case Hx)

Infrared radiation causes what type of secondary cataract?

Exfoliation of the anterior capsule

Degeneration of the capsule to break down and separate from rest of lens

Ectopia lentis

Displacement of the crystalline lens due to broken zonular fibers

Subluxated and luxated

Subluxated lens displacement

Caused by Marfan’s or trauma

Lens will displace towards intact zonules, edge of lens seen within pupil margin

Subluxated lens compliations

• Monocular diplopia

• Blurry dist vision

• Near blur (can’t accommodate)

Luxated/dislocated lens

Caused by trauma

Lens may travel into posterior or anterior chamber

Luxated lens complications

• Blurry dist vision

• Near blur (can’t accommodate)

• Acute angle closure if lens in anterior chamber

Other complications of ectopia lentis

• Phacodonesis

• Iridodonesis

• Monocular diplopia

• High lenticular astig

• Aphakia

Phacodonesis

Shaking of lens due to zonular weakness

Iridodonesis

Shaking iris from decreased support

Monocular diplopia

Light passes through displaced lens edge

High lenticular astig

Decentered lens alters refractive power

Aphakia

Lens fully dislocated out of visual axis