Phacomorphic glaucoma: case and review

Phacomorphic glaucoma is a lens-induced secondary angle closure glaucoma that may occur as a result of mature cataract formation. A patient with markedly asymmetric cataract and anterior chamber depth was referred after the development of significant eye pain and elevated intraocular pressure that did not respond to topical antiglaucoma medications. The presence of an asymmetric mature lens, angle closure, and intraocular pressure elevation in the affected eye led to the diagnosis of phacomorphic glaucoma. Because the patient was systemically ill, physically frail, and had poor vision in the affected eye since birth, secondary to strabismic amblyopia, initial therapy was medically directed toward pain management. Cycloplegia, corticosteroids, and aqueous suppressants successfully ameliorated the patient's intraocular pressure and adequately controlled pain. However, progression to phacolysis and subsequent failure of pain management necessitated referral for lens extraction. The diagnosis and mechanism of phacomorphic glaucoma is discussed along with a review of current treatment modalities.