Medical Care

Initial treatment of phacolytic glaucoma is focused upon acute lowering of IOP using a combination of topical and systemic IOP-lowering agents. Topical steroids also may facilitate IOP lowering and decrease pain.

Medical therapy is only a temporizing measure until cataract surgery can be scheduled.

Surgical Care

The definitive treatment of phacolytic glaucoma (PG) is cataract extraction. Extracapsular cataract extraction (eg, phacoemulsification) with an intraocular lens implant has largely replaced intracapsular cataract extraction as the procedure of choice.^{[16, 17, 9, 18]}

If PG is caused by a lens that has dislocated into the vitreous cavity, the procedure of choice is pars plana vitrectomy with removal of the lens from within the vitreous cavity.

Diet

Instruct patients not to eat or drink if emergency cataract extraction is being considered.

Prevention

Removal of mature or hypermature cataracts may be preventive.

Further Outpatient Care

In most cases, IOP begins to rapidly normalize following cataract extraction, allowing discontinuation of ocular medications. A minority of patients will have persistent elevation of IOP requiring long-term medical therapy or filtering surgery to control the glaucoma.

Further Inpatient Care

Inpatient care is not usually necessary for phacolytic glaucoma unless the patient is briefly hospitalized following emergency cataract extraction.

Medication

Kanski JJ. Lens-related glaucoma. Clinical Ophthalmology. 5th ed. 2003. 239.
Richter C. Lens-induced open angle glaucoma: phacolytic glaucoma (lens protein glaucoma). Ritch R, Shields MB, Krupin T, eds. The Glaucomas. 2nd ed. St Louis: Mosby; 1996. 1023-1026.
Stamper R, Lieberman M, Drake M. Secondary open-angle glaucoma: phacolytic glaucoma. Becker-Shaffer's Diagnosis and Therapy of the Glaucomas. 7th ed. St Louis, Mo: Mosby; 1999. 324-326.
Kim IT, Jung BY, Shim JY. Cholesterol crystals in aqueous humor of the eye with phacolytic glaucoma. J Korean Ophthalmol Soc. 2000 Sept. 41(9):2003-7.
Mavrakanas N, Axmann S, Issum CV, Schutz JS, Shaarawy T. Phacolytic Glaucoma: Are There 2 Forms?. J Glaucoma. 2011 Mar 16. [QxMD MEDLINE Link].
Khandelwal R. Ocular snow storm: an unusual presentation of phacolytic glaucoma. BMJ Case Rep. 2012. 2012:[QxMD MEDLINE Link].
Mavrakanas N, Axmann S, Issum CV, Schutz JS, Shaarawy T. Phacolytic glaucoma: are there 2 forms?. J Glaucoma. 2012 Apr-May. 21(4):248-9. [QxMD MEDLINE Link].
Pradhan D, Hennig A, Kumar J. A prospective study of 413 cases of lens-induced glaucoma in Nepal. Indian J Ophthalmol. 2001. Jun;49(2):103-7. [QxMD MEDLINE Link].
Mandal AK, Gothwal VK. Intraocular pressure control and visual outcome in patients with phacolytic glaucoma managed by extracapsular cataract extraction with or without posterior chamber intraocular lens implantation. Ophthalmic Surg Lasers. 1998 Nov. 29(11):880-9. [QxMD MEDLINE Link].
Allingham RR, Damji KD, Freedman S. Glaucomas associated with disorders of the lens: phacolytic (lens protein) glaucoma. Shields Textbook of Glaucoma. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005: 262-3.
Chu ER, Durkin SR, Keembiyage RD, Nathan F, Raymond G. Nineteen-year delayed-onset phacolytic uveitis following dislocation of the crystalline lens. Can J Ophthalmol. 2009 Feb. 44(1):112. [QxMD MEDLINE Link].
Gadia R, Sihota R, Dada T, Gupta V. Current profile of secondary glaucomas. Indian J Ophthalmol. 2008 Jul-Aug. 56(4):285-9. [QxMD MEDLINE Link].
Sihota R, Kumar S, Gupta V, Dada T, Kashyap S, Insan R, et al. Early predictors of traumatic glaucoma after closed globe injury: trabecular pigmentation, widened angle recess, and higher baseline intraocular pressure. Arch Ophthalmol. 2008 Jul. 126(7):921-6. [QxMD MEDLINE Link].
Alliman KJ, Smiddy WE, Banta J, Qureshi Y, Miller DM, Schiffman JC. Ocular trauma and visual outcome secondary to paintball projectiles. Am J Ophthalmol. 2009 Feb. 147(2):239-242.e1. [QxMD MEDLINE Link].
Yoo WS, Kim BJ, Chung IY, Seo SW, Yoo JM, Kim SJ. A case of phacolytic glaucoma with anterior lens capsule disruption identified by scanning electron microscopy. BMC Ophthalmol. 2014. 14:133. [QxMD MEDLINE Link].
Braganza A, Thomas R, George T. Management of phacolytic glaucoma: experience of 135 cases. Indian J Ophthalmol. 1998 Sep. 46(3):139-43. [QxMD MEDLINE Link].
Chen TC. Lens-induced glaucomas: surgical techniques and complications. Middle East J Ophthalmol. 2004 May. 12(1):40-52.
Venkatesh R, Tan CS, Kumar TT, Ravindran RD. Safety and efficacy of manual small incision cataract surgery for phacolytic glaucoma. Br J Ophthalmol. 2007 Mar. 91(3):279-81. [QxMD MEDLINE Link]. [Full Text].
Alm A, Grierson I, Shields MB. Side effects associated with prostaglandin analog therapy. Surv Ophthalmol. 2008 Nov. 53 Suppl1:S93-105. [QxMD MEDLINE Link].

Media Gallery

Microscopy of the aspirate at the time of cataract extraction shows clumped, notched rectangular platelike crystals from the aqueous of a patient with phacolytic glaucoma (X160). Reproduced from J Korean Ophthalmol Soc 2000 Sep;41(9): Copyright © 2000, Korean Ophthalmological Society. All rights reserved.
Microscopy of the aspirate at the time of cataract extraction of a patient with phacolytic glaucoma shows round, regular cells with foamy cytoplasm consistent with macrophages (*). A leukocyte (white arrow) and an erythrocyte (black arrow) also are seen (X160). Reproduced from J Korean Ophthalmol Soc 2000 Sep;41(9): Copyright © 2000, Korean Ophthalmological Society. All rights reserved.

of 2

Author

Kayoung Yi, MD, PhD Associate Professor, Department of Ophthalmology, Hallym University, Kangnam Sacred Heart Hospital, Korea

Kayoung Yi, MD, PhD is a member of the following medical societies: Korean Medical Association, Korean Ophthalmological Society, Korean Board of Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Teresa C Chen, MD, FACS Associate Professor, Department of Ophthalmology, Harvard Medical School; Director of Clinical Affairs, Glaucoma Service, Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Teresa C Chen, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Women in Ophthalmology, Inc

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Inci Irak Dersu, MD, MPH Associate Professor of Clinical Ophthalmology, State University of New York Downstate College of Medicine; Attending Physician, SUNY Downstate Medical Center, Kings County Hospital, and VA Harbor Health Care System

Inci Irak Dersu, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Additional Contributors

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.