Phacolytic Glaucoma : A Case Report

Crystalline-origin ocular hypertonia (HTO) is a medical and surgical emergency that presents numerous therapeutic challenges regarding the control of hypertonia, the surgical extraction of the lens with a high risk of vitreous prolapse, and the correction of anisometropia. Visual prognosis depends on the severity and duration of ocular hypertonia, as well as irreversible damage to the corneal endothelium and optic nerve.

We report the case of a 65-year-old patient with phacolytic glaucoma who sought care at the ophthalmological emergency department 20 août due to red and painful left eye.

We report the case of a 65-year-old patient with phacolytic glaucoma who sought care at the ophthalmological emergency department on August 20th due to red and painful left eye.

RESULTS: Ophthalmological examination of the left eye revealed reduced visual acuity to light perception (PL+) and intraocular pressure of 38 mmHg. The anterior segment examination showed conjunctival hyperemia with a perilimbal circle, corneal edema hindering examination of the rest of the eye structures, and the anterior chamber contained Tyndall 2+ cells, a fibrin clot, and some crystalline masses superiorly, with the lens appearing opaque. Posterior segment elements were inaccessible for examination. The patient was hospitalized, and the medical treatment included mannitol infusion, local corticosteroids, and hypotensive eye drops. 

DISCUSSION: Crystalline-origin hypertonia is a rare clinical form in developed countries where cataract management is early. However, it remains quite common in our context. Phacolytic glaucoma is an inflammatory glaucoma caused by the leakage of crystalline proteins through the anterior capsule of a hypermature Morgagnian cataract or through capsular rupture in the context of trauma, surgery, or Nd-Yag laser. The clinical presentation of an intumescent cataract complicated by ocular hypertonia due to pupillary block is that of an acute angle-closure glaucoma crisis. 

Intumescent cataracts are the most common causes of crystalline-origin hypertonia in our country. Lens extraction must be performed urgently to prevent optic nerve atrophy. Any delay in management will lead to the formation of goniosynechiae, justifying the indication for filtering surgery.