Who can have phacolitic glaucoma?

Facial glaucoma is an open-angle glaucoma that occurs against the background of an overripe cataract. Symptoms of the disease resemble an acute attack of glaucoma, which is accompanied by a partial decrease in vision, acute pain in the eye area, increased intraocular pressure, swelling and reddening of the cornea. Reflex of the fundus is strongly attenuated or absent completely.

The transition of overripe cataract into phacolithic glaucoma is associated with the release of soluble proteins from the lens. The analysis of the intraocular fluid gives a picture of the accumulation of large transparent cells and macrophages. The surface of the lens is covered with white spots, which are considered a product of macrophage activity. Proteins of the lens, seeping from the anterior capsule, are phagocytosed and acquire a white color.

Causes of

There is a phacolithic glaucoma as a result of blockage of the trabecular filter. Large molecules of the lens protein go through the affected anterior capsule and enter the extra-ocular liquid.

Outflow from the trabecular network is blocked, as a result of which the intraocular pressure rises to 60-70 mm Hg. Since in studies very often macrophages were found in the liquid, the pressure increase was attributed to their effect for a long time. However, it was subsequently proved that the blocking by large proteins leads to this result. Moreover, macrophages are able to act as purifiers, removing soluble proteins from the eye fluid and the trabecular apparatus.

Clinical studies conducted by Epstein and a group of scientists have proved that the blocking of the trabecular network is caused precisely by large protein molecules. For the study, the intraocular fluid of patients was taken, in which a large number of high molecular weight proteins were detected. As the cataract matures, the concentration of proteins increases, while in some samples macrophages are not detected.

Basically, the appearance of phacolitic glaucoma affects elderly people over 70 years old who have an overripe cataract.

Detection of phacolitic glaucoma

This disease is most prevalent in poorly developed countries, where cataracts are detected at rather late stages. For the diagnosis, as a rule, enough clinical research.

For early detection of glaucoma the following methods are used:

• Biomicroscopy: used for unilateral overripe cataracts. Symptoms of glaucoma can be a deep anterior chamber of the eye and the presence of whitish particles in its moisture.
• Gonioscopy: the iris-corneal eye is revealed, macrophages are detected in the liquid, which are phagocytosed by the proteins of the lens.

Methods of treatment

• Medication - is aimed at eliminating the symptoms of the disease, reducing intraocular pressure with drugs acetazolamide and glycerol. The basis of drug therapy is the use of beta-adrenoblockers and inhibitors of carbonic anhydrase. With a pronounced inflammatory process, glucocorticoids are used.   
• Surgical - after intraocular pressure has returned to normal, cataracts should be removed immediately. Particles of macro-proteins are washed out of the eye, cataract extraction is performed and an artificial lens is implanted into the posterior chamber. The operation is rather complicated, requiring attention so as not to damage the girdle with anterior capsulotomy.

Complications observed after treatment of glaucoma. Medication can lead to the development of allergic reactions and side effects. In such cases, the drugs are recommended to be replaced by analogues. Untimely surgical intervention leads to long-term preservation of intraocular pressure and loss of visual acuity.