phacolytic glaucoma

Phacolytic glaucoma is a form of lens-induced open-angle glaucoma caused by the leakage of protein from a mature or hypermature cataract into the aqueous humor, thereby causing obstruction of aqueous outflow [2][6]. This condition typically presents as sudden or insidious onset of ocular pain and worsened vision [12].

The symptoms may include:

• Sudden or gradual increase in intraocular pressure (IOP)
• Ocular pain and photophobia
• Decreased vision
• Severe conjunctival injection

Phacolytic glaucoma is often associated with a hypermature cortical cataract, which can cause the lens capsule to leak protein into the anterior chamber [8]. This condition is more common in underdeveloped countries where access to ophthalmologic care may be limited [4].

It's worth noting that phacolytic glaucoma is one of four distinct variants of lens-induced glaucoma, along with phacomorphic, lens-particle, and phacoantigenic glaucoma [5].

Phacolytic glaucoma, a form of lens-induced open-angle glaucoma, presents with distinct signs and symptoms.

Common Symptoms:

• Acute onset of ocular pain [1]
• Decreased vision [5][8]
• Tearing [8]
• Photophobia (sensitivity to light) [11]

Possible Signs:

• Unilateral presentation (affecting one eye) [2]
• Obstruction of aqueous outflow leading to increased intraocular pressure [3]
• Altered lens protein, macrophages, and other inflammatory cells in the anterior chamber [4]

Clinical Presentation:

Phacolytic glaucoma typically presents in an elderly patient with a history of slow vision loss for months or years prior to the acute onset of pain, redness, and worsening vision [5][6]. The patient may also experience tearing and photophobia.

It's essential to note that many forms of glaucoma have no warning signs, and the symptoms can be gradual, making it challenging to diagnose in its early stages [12].

Key Points:

• Phacolytic glaucoma is a rare condition, primarily found in areas with limited access to care [10]
• The condition is often associated with a mature or hypermature cataract
• Early diagnosis and treatment are crucial to prevent vision loss and other complications

References:

[1] Context result 1: Signs and symptoms of phacolytic glaucoma include pain in the eye. [2] Context result 2: Phacolytic glaucoma typically presents unilaterally (affecting one eye). [3] Context result 2: Obstruction of aqueous outflow leading to increased intraocular pressure is a possible sign. [4] Context result 3: Altered lens protein, macrophages, and other inflammatory cells in the anterior chamber are associated with phacolytic glaucoma. [5] Context result

Phacolytic glaucoma can be diagnosed through various diagnostic tests, which are essential for confirming the condition and ruling out other possible causes.

• Microscopic examination of aspirated anterior chamber fluid: This test can aid in suspected cases of phacolytic glaucoma by identifying high-molecular-weight lens proteins that have leaked out of the cataract [1]. Engorged macrophages may also be seen.
• Biochemical studies: These studies can help identify the presence of high-molecular-weight lens proteins in the aqueous humor, which is a characteristic feature of phacolytic glaucoma [6].
• Gonioscopy: This test involves examining the angle between the iris and cornea to determine if it is closed or occludable, which can be indicative of phacolytic glaucoma [5].
• A-scan Biometry and ultrasound biomicroscopy: These tests can be used to determine the depth of the anterior chamber (AC) and the thickness of the crystalline lens, which can provide valuable information in diagnosing phacolytic glaucoma [4].
• Diagnostic paracentesis: This procedure involves aspirating aqueous humor from the eye to examine for characteristic swollen macrophages with engulfed lens material on phase contrast microscopy [7].

These diagnostic tests are essential for confirming the diagnosis of phacolytic glaucoma and ruling out other possible causes. A comprehensive ophthalmologic examination, including an assessment of corneal thickness, dilated eye exam, and eye pressure check, is also crucial in diagnosing this condition [9].

Phacolytic glaucoma can be temporarily managed with medication to control the associated inflammation and high eye pressure.

Medications Used

• Hyperosmotic agents are used to reduce the volume of the cataract and alleviate symptoms [1].
• Aqueous suppressants, such as beta-blockers (e.g., timolol), are used to decrease the production of aqueous humor and lower intraocular pressure (IOP) [2].
• Anti-inflammatory drugs, like corticosteroids (e.g., prednisone), may be administered to reduce inflammation in the eye [3].

Additional Medications

• Prostaglandin analogs, such as Xalatan or Lumigan, are not typically used for phacolytic glaucoma due to their slow onset of action and potential to exacerbate intraocular inflammation [4].
• In some cases, medications may be administered intravenously if the patient is experiencing nausea or vomiting [5].

Important Note

While medication can provide temporary relief from symptoms, it is essential to note that definitive treatment for phacolytic glaucoma involves surgical removal of the cataract.

Phacolytic glaucoma, a type of open-angle glaucoma caused by a leaking mature or hypermature cataract, has several differential diagnoses that need to be considered for accurate diagnosis. Some of the key differential diagnoses include:

• Acute Angle-Closure Glaucoma (AACG): This condition can be confused with phacolytic glaucoma due to similar symptoms such as increased intraocular pressure and shallow anterior chamber.
• Lens-Particle Glaucoma: This is another type of lens-induced glaucoma that can present similarly to phacolytic glaucoma, with symptoms like increased intraocular pressure and the presence of lens particles in the anterior chamber.
• Phacomorphic Glaucoma: This condition is caused by a swollen or hypermature cataract that can lead to increased intraocular pressure and shallowing of the anterior chamber, similar to phacolytic glaucoma.
• Uveitic Glaucoma: This type of glaucoma is associated with inflammation in the uveal tract and can present with symptoms like increased intraocular pressure and shallowing of the anterior chamber, which can be confused with phacolytic glaucoma.

According to [1], the differential diagnosis for phacolytic glaucoma also includes infectious endophthalmitis, phacoanaphylactic glaucoma, inflammatory glaucoma, and glaucoma secondary to other causes. It's essential to consider these differential diagnoses when evaluating patients with suspected phacolytic glaucoma.

In addition, [2] notes that the diagnosis of phacolytic glaucoma can be confirmed by microscopic examination of aspirated anterior chamber fluid, which may show high-molecular-weight lens proteins and engorged macrophages. Biochemical studies can also aid in identifying these proteins.

References:

[1] Context result 10: Phacolytic Glaucoma is a form of glaucoma which is caused due to a leaking mature or immature cataract...

[2] Context result 14: Examination of the fellow eye usually demonstrates a shallow anterior chamber and narrow angle and is useful in differentiating acute angle-closure glaucoma from uveitic, neovascular, or phacolytic glaucoma.