The lens of your eye is made up of proteins, macrophages (specialized cells that detect and destroy harmful bacteria and other organisms, as well as activate other cells), and epithelial tissue. Certain types of glaucoma have lens-related causes that require different methods of diagnosis and treatment.* 

Types of lens-induced glaucoma include:

• Lens-induced secondary angle-closure glaucoma
• Glaucoma induced by lens dislocation
• Lens-induced open-angle glaucoma
• Lens particle glaucoma
• Phacoantigenic glaucoma

It’s important to recognize the symptoms of each and know what to expect from treatment.

What are the types of lens-induced glaucoma?

Lens induced secondary angle-closure glaucoma

Phacomorphic glaucoma, i.e., lens-induced secondary angle-closure glaucoma, may result when a mature cataract pushes your iris forward or causes your lens to swell, obstructing fluid movement and drainage. Diagnosis of phacomorphic glaucoma is based on the following in the affected eye:

• Eye pain
• History of decreased vision
• Evidence of a mature cataract
• Angle closure
• Elevated intraocular pressure (IOP)

Initial treatment to lower your IOP is done with topical medications, such as topical beta blockers or carbonic anhydrase inhibitors (CAIs). If your IOP cannot be controlled topically, then laser therapy and/or cataract extraction is usually performed.

Glaucoma induced by lens dislocation

Secondary angle-closure glaucoma may occur if the lens is displaced from its normal position. Dislocation can result from trauma or certain systemic disorders. Diagnosis is dependent on angle-closure and pupillary block, eye pain, increased IOP, reduced visual acuity, and history of lens accommodation issues and near vision. 

Treatment depends on the degree of lens dislocation and the presence of a pupillary block (an obstruction to fluid drainage between the pupil and the lens). If there’s no pupillary block, eye drops and close monitoring may suffice. If there is a pupillary block, laser therapy may be indicated. Lens removal definitively treats total dislocation.

Lens induced open-angle glaucoma

Phacolytic glaucoma, or lens-induced open-angle glaucoma, is caused by the leakage of lens proteins and other materials through a mature cataract. This leads to inflammation and the obstruction of the trabecular meshwork—the eye’s natural drainage system. 

Phacolytic glaucoma presents with eye pain, light sensitivity, increased IOP, and corneal swelling. Patients are first treated with topical steroids, eye fluid suppressants, and cycloplegia (paralysis of the ciliary muscle) to reduce inflammation and IOP before they eventually undergo cataract removal.

Lens-particle glaucoma

Lens particle glaucoma is a secondary event that can follow eye surgery, such as cataract removal or a penetrating lens injury. The disruption of the lens releases particle material that blocks fluid drainage.

Symptoms of lens-particle glaucoma include increased IOP, corneal swelling, and displaced lens particles. These symptoms can be delayed for weeks, months, or even years after the causal event, so a history of eye surgery or trauma helps to diagnose the issue. 

Initial therapy involves topical medications, like eye drops, to reduce IOP and steroids to lower inflammation. If these prove insufficient, surgical removal of the lens may be necessary.

Phacoantigenic glaucoma

Formerly known as phacoanaphylaxis, phacoantigenic glaucoma is an inflammatory response that can result from infection or a variety of autoimmune, toxic, allergic, drug-related, or tumor-promoting conditions. 

Phacoantigenic glaucoma generally occurs within two weeks following cataract surgery or trauma. Ophthalmologic tests can detect specific reactions inside your eye that would confirm this diagnosis.

Initial therapy is to control the intraocular pressure with IOP-lowering medications and to reduce the inflammation with topical steroids. If medical treatment is unsuccessful, surgical removal of the residual lens material is indicated.

*Luna, G. & Eliassi-Rad, B. (2020, Mar. 13). Lens Induced Glaucomas. American Academy of Ophthalmology. https://eyewiki.org/Lens_Induced_Glaucomas 

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