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Phacomorphic Glaucoma
Introduction
Blindness affects an essential 12.5 million
people in India, with cataract being the
leading cause. This together with social and
economic factors, often result in delayed
presentation until advanced stages such
as intumescent, mature and hyper mature
cataracts. Hence complications such as lens
induced glaucoma are more common.
Classification
Lens induced glaucoma can be divided into
two major categories.
• Open angle glaucoma
a. Phacolytic
b. Phacoanaphylatic
c. Phocotoxic
• Closed angle glaucoma (Pupillary block):
a. Phacomorphic glaucoma
b. Ectopia lentis
Phacomorphic Glaucoma
This condition is seen in eyes with a swollen
cataractous lens. The cataract progresses
enough to become intumescent with an
increased antero – posterior length, which
leads to pupillary block with secondary angle
closure and rise in intra ocular pressure.
Clinical features
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Eye pain
Headache
Blurred vision
Perception of haloes around light
Clinical
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Nausea
Vomiting
Bradycardia
Diaphoresis due to vasovagal response.
(These symptoms usually occur at night
because mid dilated pupil during sleep
aggravates pupillary block.
Clinical Examination
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Reveals reduced visual acuity
Ciliary congestion
Corneal edema
Reduced anterior chamber depth
Cells and flare
Mid dilated pupil
Intumescent cataractous lens
Significantly elevated intra ocular
pressure
Treatment
It focuses on 2 objectives
• Lower the intra ocular pressure as soon as
possible.
• Prevent the diseased and fellow eye from
another occurnece.
Initially intra ocular pressure lowering
medications are used,
• Topical beta – blockers (Ex. Brimonidine)
• Carbonic anhydrase inhibitor (Ex. Tab.
Diamox)
• Hyperosmotic agents (Ex. IV. Mannitol)
• Pilocarpine
Intumescent – enlarged or swollen; Bradycardia: condition in which pulse rate goes below 60 beats per minute; Diaphoresis:
Sweating; Vasovagal: A feeling of discomfort mediated by Vagus nerve
A R A V I N D
E Y E
C A R E
S Y S T E M
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Surgical management
Surgical management includes
• ECCE
• MSICS
• Trabeculectomy combined with cataract
surgery may be required in patients with
long duration of glaucoma, with more
likelihood of developing peripheral
anterior synechiae.
• Ahmed who have glaucoma valve can
also be implanted along with cataract
surgery for patients phacomorphic
glaucoma with late presentation. They
reported good intra ocular pressure
control in teens during follow up.
-Ms. Varalakshmi
Glaucoma clinic,
Aravind - Pondicherry
Ocular Diseases
Key points to remember
• Inflammed condition of the eyelids should be treated by hot fomentation .
• In all abnormal conditions of the eyelid corneal damage may occur
• In corneal ulcers the conditions of the sac and diabetic status of patient should be
assessed.
• No bandage should be applied in corneal ulcer or conjunctivitis.
• In allergic conjunctivitis and post-operative follow up cases, pationt should be given
proper advice if steroids are used, as they can get glaucoma if steroid is used long term.
• While dispensing spectacles for refractive errors, the pupillary center and the optical
center must be aligned correctly.
• Amblyopia should be identified and treated before 8 years after which there will be not
much improvement.
• All diabetic retinopathy patients should come for regular follow up.
• Optic neuritis has good visual recovery if treated appropriately with steroids.
• Thyroid ophthalmopathy is the most common cause of proptosis in adults.
• Schiotz tonometry should not be done in active corneal lesions and conjunctivitis.
• Dilating drops should not be applied in shallow anterior chamber and phaco morphic
glaucoma.
• Lagophthalmos is found facial nerve palsy.
• Discharge from the eyes is due to dacryocystitis.
• Foreign body sensation is feel conjunctivitis.
MSICS - Manual small incision cataract surgery; Glaucoma Valve - a medical shunt used to reduce IOP; Synechiae - iris sticking
to the cornea
Compassion January - March, 2014