Phacomorphic glaucoma is an

eye disease This is a partial list of human eye diseases and disorders. The World Health Organization (WHO) publishes a classification of known diseases and injuries, the International Statistical Classification of Diseases and Related Health Problems, or ...

that can occur due to a neglected advanced

cataract A cataract is a cloudy area in the lens (anatomy), lens of the eye that leads to a visual impairment, decrease in vision of the eye. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or ...

. In this, the mature cataractous

lens A lens is a transmissive optical device that focuses or disperses a light beam by means of refraction. A simple lens consists of a single piece of transparent material, while a compound lens consists of several simple lenses (''elements'') ...

cause secondary

angle closure glaucoma Glaucoma is a group of eye diseases that can lead to damage of the optic nerve. The optic nerve transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of ...

. The presence of an asymmetric mature cataractous lens, shallow or closed

anterior chamber angle The anterior chamber angle is a part of the eye located between the cornea and iris which contains the trabecular meshwork. The size of this angle is an important determinant of the rate aqueous humour flows out of the eye, and thus, the intraocu ...

, raised

intraocular pressure Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated t ...

(IOP) and other typical signs and symptoms of angle-closure glaucoma in the eye may lead to a diagnosis of phacomorphic glaucoma. Cataract surgery after initial IOP control with medication is the only treatment. Phacomorphic glaucoma is one of the most common causes of secondary angle closure glaucoma in developing countries like India.

Pathophysiology

A mature and bulging lens causes pupillary block and the iris to be pushed forward. A forward iris closes the angle and obstructs

aqueous humor The aqueous humour is a transparent water-like fluid similar to blood plasma, but containing low protein concentrations. It is secreted from the ciliary body, a structure supporting the lens of the eyeball. It fills both the anterior and the po ...

flow. This leads to elevated intraocular pressure and

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve i ...

damage. Rarely direct compression of angle by intumescent lens may also cause angle closure.

Signs and symptoms

Patient may come with the complaint of significant eye pain. Eye examination will show an elevated intraocular pressure. IOP did not respond to topical antiglaucoma drugs. Asymmetric mature cataractous lens, shallow or closed angle of anterior chamber, an elevated IOP and other typical signs and symptoms of angle-closure glaucoma in the eye led to the diagnosis of Phacomorphic glaucoma.

Investigations

Tonometry Tonometry is the procedure that eye care professionals perform to determine the intraocular pressure (IOP), the fluid pressure inside the eye. It is an important test in the evaluation of patients at risk from glaucoma. Most tonometers are calib ...

is used to measure intraocular pressure.

Gonioscopy In ophthalmology, gonioscopy is a routine procedure that measures the angle between the iris (anatomy), iris and the cornea (the iridocorneal angle), using a goniolens (also known as a gonioscope) together with a slit lamp or operating microscope ...

is the gold-standard for measuring angle of anterior chamber and confirming angle closure.

Treatment

Treatment of phacomorphic glaucoma may require medical therapy, laser peripheral

iridotomy An iridectomy, also known as a surgical iridectomy or corectomy, is the surgical removal of part of the iris.Cline D; Hofstetter HW; Griffin JR. ''Dictionary of Visual Science''. 4th ed. Butterworth-Heinemann, Boston 1997. Cataract surgery should be done after initial IOP control with medication or laser.

Epidemiology

Phacomorphic glaucoma is one of the most common (incidence 3.91%) causes of secondary angle closure glaucoma in developing countries like India.

References