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Clinical Review of Lens Anomalies

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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  1. Clinical Review of Lens Anomalies Optometry 8370 Winter 2008

  2. 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

  3. 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

  4. 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”

  5. Congenital cataract - Rubella

  6. Congenital anterior polar opacity

  7. Nuclear cataract

  8. Cortical cataract

  9. PSC - age

  10. ASC - traumatic

  11. PSC - inflammation

  12. Capsular / cortical cataract secondary to chronic Thorazine therapy

  13. Cataract - excema

  14. Suture barbs

  15. Eschnig’s pearls

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

  17. CME s/p CE

  18. 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

  19. 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

  20. 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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