symptoms of ectopic and dislocated lens, early symptoms and signs of ectopic and dislocated lens
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Symptoms of ectopic and dislocated lens
Related symptoms: diplopia tremor corneal ulcer
According to the degree and shape of crystal dislocation, it can be divided into incomplete dislocation and complete dislocation.
1. Incomplete dislocation of crystal
The displaced lens is still in the pupillary area, in the vitreous cavity in the posterior plane of iris, and the symptoms of incomplete dislocation of lens depend on the degree of lens displacement. If the axis of the lens is still on the visual axis, only crystalline myopia caused by relaxation of suspensory ligament and increased curvature of the lens will occur. If the crystal axis is inclined horizontally, vertically or obliquely, it can lead to severe astigmatism which is difficult to correct with glasses or contact lenses. The more common incomplete dislocation is the longitudinal displacement of lens, which may lead to monocular diplopia. Eye slit lamp examination shows that the anterior chamber is deep, iris tremor, crystal is gray, and even broken suspensory ligament can be seen in the equator. Vitreous hernia can be detached into the anterior chamber with pigment on the surface; Crescent-shaped fundus reflection and binocular bottom image can be seen under ophthalmoscope.
2. Total dislocation of crystal
The shifted crystal is completely away from the pupil area, and the crystal can be shifted or produced:
(1) Pupil incarceration;
(2) The crystal is detached from the anterior chamber;
(3) The crystal breaks out of the vitreous cavity, floats on the vitreous body or sinks into the vitreous body;
(4) The lens breaks into the space under retina and sclera through retinal hole;
(5) The lens penetrates under conjunctiva or ocular fascia through corneal ulcer perforation and scleral rupture.
Total dislocation of crystal is more serious than incomplete dislocation of crystal. The lens can detach from the pupil area to produce pupil incarceration, which often occurs after trauma, when the axis of the lens rotates 90 degrees, the equator of the lens is located in the pupil area or even the lens transposes 180 degrees, and the anterior surface of the lens faces the vitreous body.
After the lens completely leaves the pupil area, the visual acuity is aphakic, the anterior chamber becomes deeper, the iris membrane is diaphragm, and the dislocated lens often moves with the change of body position in the early stage. If the crystal breaks out of the anterior chamber, it sinks below the darkened anterior chamber, and the crystal diameter is smaller than that in the normal position, but the crown increases. The crystal is transparent and oil droplet-shaped, with golden surging luster at the edge, and the crystal is cloudy and a white disk. However, in the process of lens detaching from vitreous cavity into anterior chamber through pupil, pupil block may occur in some parts, causing acute glaucoma. If the pupil area is clear, good eyesight can be maintained, and patients can tolerate it better. Sometimes overmature cataract can improve vision because the lens falls into the anterior chamber, and the lens in the anterior chamber can be gradually absorbed. However, repeated contact of the lens with the cornea causes severe iridocyclitis, corneal dystrophy, and acute glaucoma. Lens detachment into the vitreous cavity is more common than that into the anterior chamber, and patients can tolerate it better, but the final prognosis is still questionable.
The outcome of dislocated crystals varies from person to person. Many dislocated crystals can remain transparent for many years. However, dislocated crystals always develop towards denaturation. Epithelial cells decompose gradually, cortical water cleavage forms, cortical liquefaction after turbidity, lens capsule shrinkage and nuclear sinking form Morgagnian cataract, and partial and total absorption of lens is rare.
Second, diagnostic criteria
Lens dislocation caused by different reasons: According to body shape, history of trauma and status of lens dislocation, lens dislocation caused by different reasons can be diagnosed.
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