Lens dislocation

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:
  • Marfans
  • Homocystinuria
  • Ehler's Danlos
  • Tertiary syphillis
  • 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:
  • Vitreous hemorrhage
  • Acute angle closure glaucoma
  • Hyphema
  • Retinal detachment
  • Globe rupture

Lens dislocation, from tedmontgomery.com

Evaluation

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

• 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

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/