BILATERAL CHRISTMAS TREE CATARACT.

Christmas tree cataract is a rare form of cataract in elderly patients. The clinical appearance is quite typical, with the colors of the crystals that vary according to the angle of the incident light; which suggests that it is a diffractive phenomenon.

We report a case of bilateral christmas tree cataract to describe its pathogenesis and clinical aspect.

This study reports the case of a 65-year old patient with no particular past medical history, presenting with progressive bilateral blurred vision. 

His best visual acuity was8/10 in the right eye and 9/10 in the left eye.

Ophthalmologic examination with dilated pupil showed multicolored sparkling opacities in the crystalline lens of both eyes. Direct focal lighting objectified a range of highly refractive, polychromatic needle-like opacities that crossed the deep cortex and the nucleus of the crystalline lens, appearing as colored lights decorating a Christmas tree. The rest of the biomicroscopic examination was normal. The diagnosis of Christmas tree cataract was made, because the cataract did not cause a significant decrease in vision, it was not removed but monitored for progression. 

This type of cataract is most commonly related to an accelerated breakdown of denatured proteins induced by elevated calcium levels in the lens. Peptides and amino acids accumulate in the reticular meshwork of the lens, and cysteine is concentrated to a level at which crystallization occurs. It’s essentially a kidney stone inside the eye. Although these cataracts are often not visually significant, they can progress and impair vision.

Christmas tree cataract is a rare form of cataract in elderly patients.

Most Christmas tree cataracts are idiopathic, but they are extremely common in patients diagnosed with type 1 myotonic dystrophy in which the deposits are smaller.