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

Lens dislocation, from tedmontgomery.com
  • 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

^Emergent diagnoses

^^Critical diagnoses

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

Disposition

See Also

External Links

References