Phacolytic

Phacolytic refers to a form of lens-induced secondary glaucoma caused by leakage of lens proteins from a hypermature or mature cataract into the anterior chamber. The diffusion of lens crystallins and other proteins triggers an inflammatory response and can obstruct the trabecular meshwork, leading to markedly elevated intraocular pressure.

Pathophysiology involves a compromised lens capsule in a hypermature cataract, allowing high-molecular-weight lens proteins to escape into the anterior chamber. This protein-rich milieu incites inflammation and accumulation of macrophages, which together with inflammatory cells can clog the trabecular meshwork and impede aqueous outflow, resulting in acute or subacute IOP rise.

Clinical features typically include sudden or subacute eye pain, redness, tearing, blurred vision, photophobia, and sometimes corneal edema. Anterior chamber cells and flare are common, and a hypermature cataract is often evident. In some cases, fine pinkish keratic precipitates may be seen on the corneal endothelium, and mild inflammatory signs may accompany the glaucoma picture.

Diagnosis is based on patient age, presence of a hypermature cataract, elevated intraocular pressure, and signs of anterior segment inflammation without signs of endophthalmitis. It is important to distinguish phacolytic glaucoma from primary angle-closure glaucoma and phacoantigenic or infectious processes. Imaging such as ultrasound may aid assessment when media is hazy.

Management centers on rapid reduction of IOP with topical and systemic anti-glaucoma medications and anti-inflammatory therapy. Definitive treatment is extraction of the affected lens with removal of the cataract and, when appropriate, the cataract capsule, to eliminate the source of leakage. Prognosis depends on prompt control of IOP and inflammation and on the integrity of the retina and optic nerve.