Emergency use of pilocarpine and pupil block glaucoma in ectopia lentis

Madill, S.; Bain, Karen E; Patton, Niall; Bennett, Harry; Singh, Jaswinder

doi:10.1038/sj.eye.6701417

Cited by 8 publications

(6 citation statements)

References 3 publications

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“…Allingham et al has suggested three types of pupillary block glaucoma induced from lens dislocation. These include pupillary block by subluxating the lens posterior to the iris, lens incarceration directly within the pupil, and complete lens dislocation into the anterior chamber 9. In this case, IOP elevation was due to posterior pupillary block, which responded dramatically to laser iridotomy.…”

Section: Discussionmentioning

confidence: 83%

Bilateral Spontaneous Anterior Lens Dislocation in a Retinitis Pigmentosa Patient

Kwon

Bae

Sohn

2007

Korean J Ophthalmol

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PurposeTo report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa (RP).MethodsA 45-year-old male with RP presented with elevated intraocular pressure (IOP) in the right eye and was treated with laser iridotomy (LI). After LI, complete crystalline lens dislocation into the anterior chamber occurred. Surgical intervention, including anterior vitrectomy, intracapsular cataract extraction (ICCE), and IOL scleral fixation was performed. Two years later, the same episode occurred in his left eye and a similar treatment was done.ResultsSurgery was successful in both eyes.ConclusionsThis is the first report of bilateral spontaneous anterior lens dislocation in a RP patient.

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Section: Discussionmentioning

confidence: 83%

Bilateral Spontaneous Anterior Lens Dislocation in a Retinitis Pigmentosa Patient

Kwon

Bae

Sohn

2007

Korean J Ophthalmol

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“…2 Ectopia lentis typically presents as bilateral, superotemporal lens subluxation with dehisced zonular fibers. 3 Although ectopia lentis occurs in 60% to 68% of patients with Marfan syndrome, dislocation into the vitreous cavity is rare, and prolapse into the anterior chamber is even more rare. 4 Anterior dislocation can lead to endothelial damage and acute pupillary block glaucoma.…”

Section: Discussionmentioning

confidence: 99%

“…4 Anterior dislocation can lead to endothelial damage and acute pupillary block glaucoma. 3,4 The earliest account of anterior lens dislocation in Marfan syndrome was in 1957, 5 but there is no standardized approach to management. Pars plana vitrectomy and lensectomy (PPV/PPL) is the definitive treatment, but this carries a significant risk of retinal detachment (17.2% at 3-year follow-up).…”

Section: Discussionmentioning

confidence: 99%

“…Ophthalmic abnormalities include cornea plana, keratoconus, increased axial length, iris hypoplasia, ciliary muscle dysfunction, and ectopia lentis . Ectopia lentis typically presents as bilateral, superotemporal lens subluxation with dehisced zonular fibers . Although ectopia lentis occurs in 60% to 68% of patients with Marfan syndrome, dislocation into the vitreous cavity is rare, and prolapse into the anterior chamber is even more rare .…”

Section: Discussionmentioning

confidence: 99%

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Acute Eye Pain Following Prolonged Face-Down Positioning in a Patient With Marfan Syndrome

Scott¹,

Weng

2017

JAMA Ophthalmol

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A woman in her late teens with Marfan syndrome and a history of dislocated lenses presented with blurry vision, pain, and photophobia in her right eye. Her symptoms began 6 hours before presentation after she had been napping face-down on her desk for 30 minutes. Her medical history included aortic repair and cervical spine abnormalities. Her ocular history was pertinent for high myopia and contact lens wear, a posteriorly dislocated crystalline lens suspended in the vitreous cavity in her right eye, and a superotemporally subluxated crystalline lens in her left eye. Her lenses had been observed for years without intervention. The patient's family history was unknown because she was adopted. Her medications included oral aspirin and irbesartan.Visual acuity was counting fingers OD (without correction) and 20/30 OS (with correction). The right pupil was corectopic and fixed at 5 mm while the left pupil was round and reactive; no afferent pupillary defect was seen. Extraocular motility was normal. Intraocular pressures (IOPs) were 43 mm Hg OD and 14 mm Hg OS. Examination of the right eye revealed conjunctival injection, corneal stromal edema with Descemet folds and lenticulocorneal touch, a shallowed anterior chamber, and a lens protruding through the pupil with the superior edge in the anterior chamber (Figure 1A). The posterior view was limited to red reflex. The left eye was unremarkable except for a superotemporally subluxated lens (Figure 1B).

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“…3). In every case, treatment with pilocarpine makes the block worse by stimulating ciliary muscle contraction, thereby loosening the zonules and further increasing anterior lens displacement [25]. The treatment of choice is pupil dilation, positioning of the patient to replace the lens, peripheral iridotomy and often lens extraction.…”

Section: Glaucomamentioning

confidence: 99%