Glaucoma
Lens-Related Glaucoma (Phacolytic and Phacomorphic)
Also known as: lens-related glaucoma, lens induced glaucoma, phacolytic glaucoma, phacomorphic glaucoma, hypermature cataract glaucoma, intumescent cataract, lens protein glaucoma, pseudohypopyon
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Two ways an advanced cataract raises the intraocular pressure. In phacolytic glaucoma the angle is open: lens protein leaks through the capsule of a hypermature cataract and blocks the trabecular meshwork. In phacomorphic glaucoma the angle is closed: a swollen, mature lens causes pupil block and pushes the iris forward. Both present with sudden pain, poor vision and a very high pressure in an eye with a dense white cataract. Both need the pressure controlled and the lens removed by an ophthalmologist. The optometrist's job is to recognise the lens as the cause and send the patient the same day.
Recognition
Symptoms: what patients report
- Sudden pain in one eye
- Poor vision, usually on a background of long-standing poor vision from cataract
- Red eye
- Photophobia, haloes, headache or nausea, more often in the phacomorphic form
Signs: what the examination shows
- Dense white mature or hypermature cataract
- Very high intraocular pressure
- Corneal oedema and conjunctival injection
- Phacolytic: open angle with no synechiae, large white particles floating in a deep anterior chamber, sometimes settling as a pseudohypopyon
- Phacomorphic: shallow anterior chamber, closed angle and a forward-bowed iris, resembling primary acute angle closure
- A fellow eye with a deep chamber and open angle, which argues against primary angle closure
What OptoGuide™ covers for lens-related glaucoma (phacolytic and phacomorphic)
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting