Lens dislocation: Difference between revisions
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==Background== | ==Background== | ||
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]] | |||
*aka Ectopia Lentis | *aka Ectopia Lentis | ||
*Dislocation: anterior or posterior displacement of lens due to complete separation of lens zonule fibers | *Dislocation: anterior or posterior displacement of lens due to complete separation of lens zonule fibers | ||
**Subluxation: incomplete disruption of lens zonule fibers | **Subluxation: incomplete disruption of lens zonule fibers | ||
*[[Acute angle closure glaucoma]]: can result when anteriorly displaced lens obstructs aqueous flow | *[[Acute angle closure glaucoma]]: can result when anteriorly displaced lens obstructs aqueous flow | ||
*Lens capsule disruption can cause lens stroma to swell and become | *Lens capsule disruption can cause lens stroma to swell and become cloudy→ acute glaucoma and traumatic cataracts | ||
===Causes=== | ===Causes=== | ||
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*Less commonly due to [[lightening]]/[[electrocution]] | *Less commonly due to [[lightening]]/[[electrocution]] | ||
*Can occur after minor or no trauma in patients with: | *Can occur after minor or no trauma in patients with: | ||
** | **[[Marfan syndrome]] | ||
**Homocystinuria | **Homocystinuria | ||
** | **[[Ehlers-Danlos syndrome]] | ||
**Tertiary | **Tertiary [[syphilis]] | ||
**Prior cataract surgeries | **Prior cataract surgeries | ||
==Clinical Features== | ==Clinical Features== | ||
*Red, painful eye | [[File:LensDislocationPic.jpg|thumb|Lens dislocation, from tedmontgomery.com]] | ||
*Diplopia, reduced visual acuity | *[[red eye|Red]], [[eye pain|painful eye]] | ||
*Floaters | *[[Diplopia]], [[vision loss|reduced visual acuity]] | ||
*[[Floaters]] | |||
*+/- iris tremor after rapid eye movement | *+/- iris tremor after rapid eye movement | ||
*Raised intraocular pressure, if aqueous flow blocked | *Raised [[intraocular pressure]], if aqueous flow blocked | ||
*Slit lamp: edge of subluxated lense can be seen with dilated pupil | *[[Slit lamp]]: edge of subluxated lense can be seen with dilated pupil | ||
===Associated with=== | |||
*[[Vitreous hemorrhage]] | |||
*[[Acute angle closure glaucoma]] | |||
*[[Hyphema]] | |||
*[[Retinal detachment]] | |||
*[[Globe rupture]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Unilateral red eye DDX}} | {{Unilateral red eye DDX}} | ||
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*Evaluate for other injuries | *Evaluate for other injuries | ||
*Slit lamp exam, visual acuity | *Slit lamp exam, visual acuity | ||
*Ultrasound | *[[ocular ultrasound|Ultrasound]] | ||
**Lense displaced from usual position | **Lense displaced from usual position | ||
**evidence of other associated traumatic injuries | **evidence of other associated traumatic injuries | ||
*Measure intraocular pressure with [[Tonopen]] | *Measure [[intraocular pressure]] with [[Tonopen]] | ||
==Management== | ==Management== | ||
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*[[Blunt orbital trauma]] | *[[Blunt orbital trauma]] | ||
*[[Vitreous hemorrhage]] | *[[Vitreous hemorrhage]] | ||
*[[Acute angle glaucoma]] | *[[Acute angle closure glaucoma]] | ||
*[[Hyphema]] | *[[Hyphema]] | ||
*[[Retinal detachment]] | *[[Retinal detachment]] | ||
Latest revision as of 21:39, 18 January 2023
Background
- aka Ectopia Lentis
- Dislocation: anterior or posterior displacement of lens due to complete separation of lens zonule fibers
- Subluxation: incomplete disruption of lens zonule fibers
- Acute angle closure glaucoma: can result when anteriorly displaced lens obstructs aqueous flow
- Lens capsule disruption can cause lens stroma to swell and become cloudy→ acute glaucoma and traumatic cataracts
Causes
- Most commonly due to blunt eye trauma
- Less commonly due to lightening/electrocution
- Can occur after minor or no trauma in patients with:
- Marfan syndrome
- Homocystinuria
- Ehlers-Danlos syndrome
- Tertiary syphilis
- Prior cataract surgeries
Clinical Features
- Red, painful eye
- Diplopia, reduced visual acuity
- Floaters
- +/- iris tremor after rapid eye movement
- Raised intraocular pressure, if aqueous flow blocked
- Slit lamp: edge of subluxated lense can be seen with dilated pupil
Associated with
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Evaluate for other injuries
- Slit lamp exam, visual acuity
- Ultrasound
- Lense displaced from usual position
- evidence of other associated traumatic injuries
- Measure intraocular pressure with Tonopen
Management
- Optho consult (emergently if elevated IOP!)
- Optho will either repair surgically or observe, depending on displacement and associated injuries/symptoms
Disposition
See Also
- Blunt orbital trauma
- Vitreous hemorrhage
- Acute angle closure glaucoma
- Hyphema
- Retinal detachment
- Globe rupture
External Links
- Video of slit lamp exam of dislocated lens: http://www.rootatlas.com/wordpress/video/579/lens-subluxation-with-vitreous-video/