Phacolytic glaucoma and lens-induced uveitis

The pathogenesis of lens-induced uveitis and phacolytic glaucoma is still not fully understood. The authors report a case of a 62-year-old white female, with bilateral lens dislocation into the vitreous, who presented clinical and pathological features of phacolytic glaucoma in the left eye. The ultrastructural study of aqueous and vitreous aspirates showed lenticular fragments and macrophages with lipofuscin granules and phagocytic vacuoles containing lens proteins. Immunocytochemistry revealed foamy macrophages immunoreactive for CD68 and HLA-DR. One year later the right eye disclosed a mild anterior granulomatous uveitis with corneal mutton-fat keratic precipitates that remained unchanged in the course of sixteen months follow-up without further treatment. These findings corroborate the possibility that, besides their mechanical and inflammatory roles in the impairment of the outflow system of the (exciting) left eye, phacolytic macrophages might also have been involved in the afferent phase of the mild chronic uveitis of the (fellow) right eye.