Lens dislocation: Difference between revisions

Revision as of 18:40, 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 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:

File:LensDislocationPic.jpeg

Lens dislocation. From tedmontgomery.com

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

Lens dislocation on US, from "Radiology Picture of the Day"

Management

Optho consult (emergently if elevated IOP!)
Optho will either repair surgically or observe, depending on displacement and associated injuries/symptoms

Disposition

External Links

Video of slit lamp exam of dislocated lens: http://www.rootatlas.com/wordpress/video/579/lens-subluxation-with-vitreous-video/

References

Authors:

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 ==Background==
-Lens dislocation or subluxation is any movement of the lens of the eye either anteriorly or posteriorly from its socket attached to the suspensory ligaments. This typically occurs due to blunt trauma to the eye, and is commonly seen in conjunction with a [[hyphema]] and/or a [[vitrious hemorrhage]]. There are conditions that predispose patients to lens dislocations from even minor traumatic events, such as [[Marfans syndrome]] (classically lens is upwards and outwards), [[Homocystinuria]] (classically lens is downwards and inwards), and Ehlers–Danlos syndrome. A emergent complication of a lens dislocation is acute angle closure glaucoma, and occurs because of disruption of the iris and the cornea.
+*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 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:
+**[[Vitreous hemorrhage]]
+**[[Acute angle glaucoma]]
+**[[Hyphema]]
+**[[Retinal detachment]]
+**[[Globe rupture]]
+[[File:LensDislocationPic.jpeg|thumb|Lens dislocation. From tedmontgomery.com]]
 ==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]]
+ [[File:LensDislocation.jpg|thumb|Lens dislocation on US, from "Radiology Picture of the Day"]]
 ==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/
 ==References==