Lens dislocation: Difference between revisions
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**Most commonly due to [[blunt eye trauma]], though less commonly due to lightening/[[electrocution]] | **Most commonly due to [[blunt eye trauma]], though less commonly due to lightening/[[electrocution]] | ||
**Can occur after minor or no trauma in patients with Marfans, homocystinuria, Ehler's Danlos, tertiary syphillis, or prior cataract surgeries | **Can occur after minor or no trauma in patients with Marfans, homocystinuria, Ehler's Danlos, tertiary syphillis, or prior cataract surgeries | ||
*[[Acute | *[[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 | *Lens capsule disruption can cause lens stroma to swell and become cloudy--> acute glaucoma and traumatic cataracts | ||
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*Associated with: | *Associated with: | ||
**[[Vitreous hemorrhage]] | **[[Vitreous hemorrhage]] | ||
**[[Acute angle glaucoma]] | **[[Acute angle closure glaucoma]] | ||
**[[Hyphema]] | **[[Hyphema]] | ||
**[[Retinal detachment]] | **[[Retinal detachment]] | ||
**[[Globe rupture]] | **[[Globe rupture]] | ||
[[File:LensDislocationPic. | [[File:LensDislocationPic.jpg|thumb|Lens dislocation, from tedmontgomery.com]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
==Evaluation== | ==Evaluation== | ||
[[File:LensDislocation.jpg|thumb|Lens dislocation on US, from "Radiology Picture of the Day"]] | |||
*Evaluate for other injuries | *Evaluate for other injuries | ||
*Slit lamp exam, visual acuity | *Slit lamp exam, visual acuity | ||
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**evidence of other associated traumatic injuries | **evidence of other associated traumatic injuries | ||
*Measure intraocular pressure with [[Tonopen]] | *Measure intraocular pressure with [[Tonopen]] | ||
==Management== | ==Management== | ||
*Optho consult (emergently if elevated IOP!) | *Optho consult (emergently if elevated IOP!) | ||
Revision as of 18:44, 8 September 2016
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
- Causes:
- Most commonly due to blunt eye trauma, though less commonly due to lightening/electrocution
- Can occur after minor or no trauma in patients with Marfans, homocystinuria, Ehler's Danlos, tertiary syphillis, or prior cataract surgeries
- 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
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
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 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/