Is lens dislocation an ocular emergency?

Lens Dislocation: An Ocular Emergency

Lens dislocation is an ocular emergency that requires immediate evaluation and management, particularly when the lens is anteriorly displaced into the anterior chamber or causing pupillary block, as this can lead to acute angle closure and vision-threatening complications.

Types of Lens Dislocation and Emergency Status

• Anterior lens dislocation (into the anterior chamber) is a true ocular emergency requiring immediate intervention due to the high risk of pupillary block, acute angle closure, and elevated intraocular pressure 1
• Posterior lens dislocation may be managed on an outpatient basis with close follow-up, but still requires prompt evaluation 2
• Lens dislocation with pupillary block is an urgent ophthalmic condition requiring immediate intervention to prevent vision loss 1

Clinical Presentation and Diagnosis

• Patients with lens dislocation typically present with:
  • Sudden vision impairment 3
  • Eye pain (in cases of pupillary block) 1
  • Elevated intraocular pressure (especially with anterior dislocation) 1
• Diagnostic evaluation should include:
  • Slit lamp examination to visualize the dislocated lens 1
  • Measurement of intraocular pressure 3
  • Evaluation for underlying systemic conditions (e.g., Marfan syndrome) 4

Urgent Management Approach

• For anterior lens dislocation with pupillary block:

  • Immediate surgical intervention is required to remove the dislocated lens 1
  • Avoid pilocarpine as it may worsen pupillary block 3
  • Control elevated intraocular pressure with appropriate medications 2

• For posterior lens dislocation:

  • Close monitoring and referral to ophthalmology for definitive management 2
  • Medical management of any elevated intraocular pressure 2

Underlying Causes to Evaluate

• Traumatic causes (most common) 5
• Systemic conditions:
  • Marfan syndrome (characterized by ectopia lentis as a cardinal feature) 4
  • Ehlers-Danlos syndrome 4
• Spontaneous dislocation (rare, but possible even in younger patients) 3

Complications of Untreated Lens Dislocation

• Acute angle closure glaucoma 1
• Corneal decompensation 6
• Retinal detachment 6
• Macular edema 6
• Permanent vision loss 6

Follow-up Care

• After surgical management, patients require:
  • Regular monitoring for complications including glaucoma, which is a significant predictor of poor outcomes 6
  • Visual rehabilitation with appropriate correction for aphakia 1
  • Evaluation of the fellow eye for prophylactic intervention if at risk 1

Special Considerations

• In patients with Marfan syndrome, lens dislocation (ectopia lentis) is a cardinal feature that should prompt systemic evaluation 4
• Young patients with spontaneous lens dislocation should be evaluated for underlying connective tissue disorders 3
• Male sex, pre-existing trauma, high myopia, and lens subluxation are significant risk factors for lens dislocation 5

Prognosis

• With prompt and appropriate management, visual outcomes can be promising 6
• Factors associated with poor visual outcomes include:
  • Glaucoma at presentation 6
  • Early lens dislocation 6
  • Development of complications such as corneal decompensation or retinal detachment 6