Lens-Particle Glaucoma Overview
The crystalline lens (commonly referred to as the lens) is located behind the pupil and iris and functions as the natural focusing lens of the eye. The lens consists of an outer covering, called the lens capsule, which contains the softer outer cortex and the harder central nucleus of the lens. See Image 1. Either or both components of the lens may cause lens-induced glaucomas, which are typically associated with inflammation, abnormally high eye pressure, and potential visual loss. Lens-particle glaucoma may be either of the open-angle glaucoma or angle-closure type.
Following initial damage to the lens, larger lens nucleus or cortex pieces may spontaneously fragment further into smaller (sometimes invisible) particles that eventually migrate into the anterior chamber, where they obstruct the flow of fluid (called aqueous humor) from the eye. In addition, these particles induce inflammation in the eye, characterized by leakage of protein and mobilization of white blood cells. These cells and protein may additionally obstruct the aqueous drainage of the eye. This obstruction in the outflow of fluid results in an increase in the pressure inside the eye, called intraocular pressure (IOP).
Eye pressure is measured in millimeters of mercury (mm Hg). Although every individual person is different, normal eye pressure typically ranges from 10-20 mm Hg. When your pressure is higher than 20-22 mm Hg, you may be at an increased risk for developing glaucoma.
High pressure inside the eye is caused by an imbalance in the production and drainage of aqueous humor. In the case of lens-particle glaucoma, the channels (called trabecular meshwork) that normally drain aqueous humor from inside the eye are blocked by microscopic lens material, protein, and white blood cells. More aqueous humor is continually being produced but cannot be drained adequately because of the blocked drainage channels. This results in an increased amount of fluid inside the eye, thus raising the pressure. See Image 2.
High pressure inside the eye can damage the optic nerve and can result in permanent vision loss. Although high pressure inside the eye, optic nerve damage, and vision loss are not all required to diagnose glaucoma, a diagnosis of glaucoma is often determined when all three criteria are present.
In the United States, the exact prevalence rate of lens-particle glaucoma has not been reported, but it is considered to be uncommon. Lens-particle glaucoma can affect men and women of any race. All ages can be affected, ranging from infancy to late adulthood, although penetrating eye injuries are known to occur more frequently in young adult men. In elderly people, lens-particle glaucoma may be diagnosed as a complication of cataract surgery; however, its occurrence following routine surgery is rare. Lens-particle glaucoma tends to develop more often as a result of injury/trauma that directly damages the lens.
Brian R Sullivan, MD
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