Clinical review of lens anomalies
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Clinical Review of Lens Anomalies. Optometry 8370 Winter 2008. Cataract Etiology (Will’s). Congenital Trauma (eye or head contusion, electrocution) Toxic (steroids, anticholinesterases, antipsychotics, many others) Intraocular inflammation (uveitis) Radiation

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Clinical Review of Lens Anomalies

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Clinical Review of Lens Anomalies

Optometry 8370

Winter 2008

Cataract Etiology (Will’s)

  • Congenital

  • Trauma (eye or head contusion, electrocution)

  • Toxic (steroids, anticholinesterases, antipsychotics, many others)

  • Intraocular inflammation (uveitis)

  • Radiation

  • Intraocular tumor (CB malignant melanoma)

  • Degenerative ocular disease (RP)

  • Systemic Dz

Cataract – Systemic Etiologies

  • DM: Often progress rapidly; usually white “snowflake” opacities in the anterior and posterior subcapsular lens

  • Wilson’s Dz: Red-brown pigment deposition in the cortex, beneath the anterior capsule (sunflower cataract); seen with a Kayser-Fleischer ring

  • Down’s syndrome

  • Atopic Dermatitis

Clinical Considerations

  • Always note layer of lens involved

  • Use appropriate drawing in chart

  • Always estimate patient’s likely VA by noting the optical clarity of your view of posterior pole structures (20/??)

  • Patient referral for CE depends on many factors

  • “s/p ECCE w PC IOL”

  • “s/p YAG capsulotomy”

Congenital cataract - Rubella

Congenital anterior polar opacity

Nuclear cataract

Cortical cataract

PSC - age

ASC - traumatic

PSC - inflammation

Capsular / cortical cataract secondary to chronic Thorazine therapy

Cataract - excema

Suture barbs

Eschnig’s pearls

Posterior capsule s/p YAG // Iris chaffing w IOL

CME s/p CE

Subluxed or Dislocated Lens

  • Subluxation: Partial disruption of the zonular fibers (more than 25% ); lens decentered, but remains partially in the pupillary aperture

  • Dislocation: Complete disruption of the zonular fibers; lens is displaced out of the pupillary aperture

  • May cause monocular diplopia, iridodonesis, phacodonesis, high astigmatism, cataract, pupillary block glaucoma, high myopia, vitreous in the AC, or AC depth asymmetry

Subluxed Lens Etiology (Will’s)

  • Trauma: Most common cause but often associated with predisposing condition (especially syphilis)

  • Marfan’s syndrome: Usually bilateral superior-temporal subluxation; often AD; increased risk of RD; associated with cardiomyopathy, aortic aneurysm, tall stature with long extremities (echocardiogram as needed)

  • Homocystinuria: Usually bilateral infero-nasal lens subluxation; AR; increased risk of RD; associated with mental retardation, skeletal deformities, high risk of thromboembolic events, esp. with general anesthesia

Subluxed Lens Etiology (cont.)

  • Weill-Marchesani syndrome: Small lens can dislocate into AC, resulting in reverse pupillary block; often AR; associated with short fingers and stature, seizures, microspherophakia, myopia, and no mental retardation

  • Others: acquired syphilis (RPR, FTA-ABS), chronic inflammation, congenital ectopia lentis, aniridia, Ehlers-Danlos syndrome, Crouzon’s Dz, high myopia, hypermature cataract, others

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