Phacolytic glaucoma is a complication of a mature or hypermature cataract. Denatured, liquefied high-molecular-weight lens proteins leak through an intact but permeable lens capsule. Macrophages ingest these lens proteins, and the trabecular meshwork becomes clogged with both the lens proteins and the engorged macrophages. The usual clinical presentation of phacolytic glaucoma consists of abrupt onset of pain and redness in a cataractous eye that has had poor vision for years. The cornea may be edematous, and significant flare reaction occurs in the anterior chamber. The lack of keratic precipitates helps distinguish phacolytic glaucoma from phacoantigenic glaucoma. White flocculent material appears in the anterior chamber and often adheres to the lens capsule as well. Intraocular pressure (IOP) is markedly elevated, and the anterior chamber angle is open, although the same material may be seen in the trabecular meshwork. Initial treatment of phacolytic glaucoma consists of controlling the IOP with IOP-lowering medications and managing the inflammation with topical corticosteroids. Surgical removal of the lens is the definitive treatment.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.