ECTOPIA LENTIS

RAMA

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Displacement of the lens from its normal position (in patellar fossa) results from partial or complete rupture of the lens zonules. Positioned just posterior to the iris and is supported by zonular fibers arising from the ciliary body.

CLINICOETIOLOGICAL

Clinico-Etiological Types
w/ Systemic Hereditary

w/o Systemic

Ectopia Lentis

Traumatic

Acquired

Consecutive/Spontaneous

Without Systemic Associations

Familial Ectopia Lentis
Bilaterally symmetrical superotemporal AD fashion

Ectopia lentis et pupillae

Pupil and lens in opposite directions Small, slit-like, and dilate-poorly pupil

Aniridia
Absence of iris

With Systemic Associations

Marfan Syndrome
AD Bilaterally symmetrical superotemporal subluxation (80%) Dislocation into anterior chamber or vitreous (20%)

With Systemic Associations

Homocystinuria:
AR, inborn error of metabolism Inferonasal

Traumatic displacement of the lens

Associated with concussion injuries. Couching is an iatrogenic posterior dislocation of lens performed as a treatment of cataract in olden days.

Consecutive or spontaneous displacement

Intraocular diseases giving rise to mechanical stretching, inflammatory disintegration or degeneration of the zonules. Hypermature cataract, buphthalmos, high myopia, staphyloma, intraocular tumours and uveitis.

TOPOGRAPHICAL

Subluxation
Partial displacement in which lens is moved sideways (up, down, medially or laterally), but remains behind the pupil. Partial rupture or unequal stretching of the zonules.

Subluxation
Clinical Features
Defective vision Uniocular diplopia Anterior Chamber deep and irregular Iridodonesis Dark Edge

Complications
Refractive error Complete dislocation Cataractous changes Uveitis Secondary glaucoma

Management
Spectacles/contact lenses Surgery Lensectomy with anterior vitrectomy

Luxation
All the zonules are severed from the lens. A dislocated lens may be incarcerated into the pupil or present in the anterior chamber, the vitreous (where it may be floating lens nutans; or fixed to retina lens fixata), sub-retinal space, subscleral space or extruded out of the globe, partially or completely.

Luxation
Clinical Features Complications

Posterior: deep anterior chamber, aphakia in pupillary area, and iridodonesis. Ophtalmoscopic examination reveals lens in the vitreous cavity. Anterior: deep anterior chamber and presence of lens in the anterior chamber. Clear lens looks like an oil drop in the aqueous.

Uveitis Secondary glaucoma

Management

Anterior: ASAP! Posterior: if only causing uveitis or uncontrolled glaucoma

Khurana, Comprehensive Ophtalmology 4th Edition (Step by Step) Vaughn and Asburys, General Ophtalmology 17th Edition

Kanski, Clinical Ophtalmology

DANK U WEL