Cataracts and Ocular Diseases

Cataracts Associated with Other Ocular Diseases

• Congenital Cataracts
  • Aniridia: Absence of iris, just pupil, leads to cataracts
  • Primary Hyperplastic Vitreous: Persistent hyaloid vascular path causes cataracts
• Acquired Cataracts
  • Uveitis (Iridocyclitis): Inflammation of the iris and ciliary body causing cataracts
  • High Myopia (16, 17 D): Extreme nearsightedness leads to cataracts
  • Glaucoma: Pressure buildup in the eye causes cataracts
    • Angle-Closure Glaucoma: Pupillary margin adhesion (synechiae) blocks the angle, leading to ischemia and necrosis of the anterior lens capsule, which blocks the angle causing Glaucomflecken.
• Retinal Detachment, Retinitis Pigmentosa, Geographic Atrophy of the Choroid can also cause cataracts.
• Neoplasia (tumors) are associated with varied cataract types.
• Secondary Cataracts and Anterior Chamber Inflammation: These are always associated, with anterior chamber inflammation occurring first. Treat inflammation before cataract surgery.
• Posterior Subcapsular Cataracts (PSC): Centrally located with irregular borders and opacity extending to the equator. Progresses over time and can affect visual acuity, but not always severely.

Ectopia Lentis (Dislocated Lens)

• Zonules are broken, lens is out of place. Can move anywhere, sometimes completely loose.
• Subluxation: Lens is partially dislocated, at least one zonule is still intact
• Ectopia Lentis: Lens is completely out of place (dislocated)
  • Weill-Marchisani Syndrome: Causes posterior, superior and inferior dislocation.
  • Familial Ectopia Lentis: Autosomal dominant, both eyes are involved and symmetrical. Subluxation is typically superior temporal.
  • Ectopia Lentis et Pupillae: Autosomal recessive, both eyes are involved and symmetrical. Pupil and lens move in opposite directions - lens subluxation is in one direction, and the pupil is peaked in the other direction.
  • Marfan Syndrome: Autosomal dominant. Long limbs, cardiovascular disease, and superior temporal subluxation of the lens. Iris transillumination, retinal detachment, and ONH glaucoma are associated findings.
  • Homocystinuria: Autosomal recessive. Light skin, fragile hair, and decreased mental development. Ectopia lentis with inferior nasal subluxation. Iris atrophy, ONH atrophy, and retinal detachment are associated findings.
  • Weill-Marchisani Syndrome: Opposite of Marfan’s. DISLOCATED into the anterior chamber. Can cause pupillary block leading to secondary angle closure glaucoma.

General Symptoms and Complications of Ectopia Lentis

• Decreased Visual Acuity: Subluxation disrupts refractive error.
• Distortion: Lens displacement causes distortion and glare.
• Double Vision: Caused by lens displacement.
• Iris Atrophy
• Cataracts
• Shallow Anterior Chamber
• ONH Glaucoma
• Retinal Detachment

Management of Ectopia Lentis

• Subluxated Lens: Correcting with pupilloplasty (distorting pupil for full IOL view), relocating, or removing. Or removal with new lens if correction is not possible.
• Anterior Dislocated Lens: Immediate removal.
• Posterior Dislocated Lens: Removal, often with vitrectomy.

Systemic Diseases Causing Cataracts

• Cutaneous Disorders
  • Atopic Dermatitis: Anterior subcapsular plaque type with potential posterior involvement, regular borders, may have spoke-like opacities.
• Muscular Disorders
  • Myotonic Dystrophy: Christmas tree cataract. Posterior subcapsular stellate opacities appear later in life.
• Metabolic Disease
  • Diabetes Mellitus: Bilateral white snowflake cataract in young ages, progressing rapidly.
    • Juvenile Diabetic Cataract: White punctate or snowflake opacities, may mature within a few days.
    • Adult Diabetic Cataract: Cortical and subcapsular opacities, progress faster than non-diabetics.
  • Wilson's Disease (Hepatolenticular Degeneration): Green sunflower cataract. Fleischer-ring (copper accumulation in eye) and cornea involvements are associated.
  • Galactosemia: Oil droplet cataract.
• Drug-Induced Cataracts
  • Phenothiazines (antipsychotics/antidepressants): Anterior polar/capsular opacities.
  • HBP medication (Amiodarone): Anterior pigmented opacities and vortex epitheliopathy.
  • Steroids (Prednisone, Hydrocortisone, Methylprednisolone): Dense, central PSC.
  • Miotics (long-acting anti-cholinesterases): Dense nuclear &/or cortical cataract.

Explore the association of cataracts with various ocular diseases through this quiz. Understand the links between congenital conditions, acquired factors such as uveitis, high myopia, glaucoma, and other retinal disorders. Test your knowledge on this critical aspect of eye health.