Enlargement of the lens

Introduction In the development of cataract, individual patients expand due to the absorption of excessive water by the lens, which increases the volume of the lens, hinders the smooth flow of the aqueous humor, and causes the internal pressure to rise. The patient may experience severe pain in the eyes, accompanied by nausea and vomiting. Such symptoms, medically known as secondary glaucoma during the expansion of the lens. Glaucoma associated with intumescent cataract caused by swelling of the lens refers to the glaucoma that occurs when the cataract of the senile cataract is inflated or the opacity of the lens is turbid.

Cause

(1) Causes of the disease

Due to the enlargement of the cataract in the lens into the expansion period. Cataracts can be age-related, or they can be traumatic cataracts caused by eyeball bruises or penetrating injuries.

(two) pathogenesis

As the swelling volume of the lens increases, the anteroposterior diameter increases, causing the lens iris to move forward, the anterior chamber becomes shallow, and the angle of the chamber narrows and closes. On the other hand, due to the advancement of the lens, the physiological pupillary block is aggravated, and the posterior chamber pressure is higher than that of the anterior chamber. The iris of the peripheral part of the bulging is pushed forward, so that the peripheral iris is closely attached to the trabecular surface, and the corner resistance occurs. The stagnation causes an increase in intraocular pressure.

an examination

Related inspection

Lens examination ophthalmoscopy

The clinical manifestations of glaucoma caused by lens swelling are very similar to those of primary acute angle-closure glaucoma with cataract. Increased intraocular pressure, mixed conjunctival hyperemia, corneal edema, anterior chamber is extremely shallow, pupil dilated. Iris keratoscopy can reveal varying degrees of angle closure. If the duration of the disease is long, the intraocular pressure is high, and permanent corner adhesion can occur. In glaucoma caused by swelling of senile cataract lens, it is mostly monocular, with a history of long-term vision loss, lens opacity and water splitting. The anterior chamber depth and the width of the angle of the eyes were asymmetrical, and the angle-closure glaucoma challenge test of the contralateral eye was negative. After the trauma, the lens capsule ruptures, and the absorbing turbidity of the aqueous humor occurs. When glaucoma caused by swelling of the lens occurred, the depth of the anterior chamber and the width of the anterior chamber were also significantly different.

Glaucoma caused by swelling of the lens after trauma has a history of obvious trauma and cataract. The first symptom of senile cataract expansion is visual loss and diagnosis of cataract. Symptoms such as eye pain, nausea, vomiting, and elevated intraocular pressure have no history of glaucoma. Clinical examination revealed mixed conjunctival hyperemia, corneal edema, shallow anterior chamber, enlarged pupil, opaque swelling of the lens, at immature or near maturity. High intraocular pressure, generally higher than 30mmHg (4.0kPa).

Differential diagnosis

Differential diagnosis of increased lens expansion:

1, lens protrusion: lens protrusion is one of the symptoms of myopia.

2, lens dislocation or subluxation: the crystal is connected to the ciliary body by the suspensory ligament, suspended in the aqueous humor. Due to trauma or surgery caused by rupture of the suspensory ligament, incomplete development of the congenital suspensory ligament or dissolution of the suspensory ligament due to intraocular lesions can cause changes in lens position, which is called crystal dislocation or subluxation.

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