In the normal eye, minute quantities of lens proteins leak out through the lens capsule. The eye appears to have immunologic tolerance to this limited antigenic stimulus. However, the release of a large quantity of lens proteins into the anterior chamber disrupts the immunologic tolerance and may trigger a severe inflammatory reaction. Phacoantigenic uveitis, previously termed phacoanaphylactic endophthalmitis, is an immune-mediated granulomatous inflammation initiated by lens proteins released through a ruptured lens capsule. This condition usually occurs following traumatic rupture of the lens capsule or after cataract surgery when cortical material is retained within the eye. Onset occurs days to weeks after the injury or surgery.
Phacoantigenic uveitis is characterized by a red, painful eye with injection, chemosis, anterior chamber cell and flare, and keratic precipitates. Occasionally, glaucoma develops due to obstruction of the trabecular meshwork and formation of synechiae. Late complications include cyclitic membrane, hypotony, and phthisis bulbi. In rare instances, phacoantigenic uveitis can give rise to an inflammatory reaction in the fellow eye. Histologic examination shows a zonal granulomatous inflammation surrounding a breach of the lens capsule. Lens extraction is the definitive therapy.
See also BCSC Section 4, Ophthalmic Pathology and Intraocular Tumors, and Section 9, Uveitis and Ocular Inflammation.
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.