Types of Cataracts & Diseases
Myotonic dystrophy is aka...
"floppy baby" syndrome
Pre-natal rubella infection can cause what other problems?
-hearing loss -nuclear cataracts -glaucoma -microcornea -fundus pigmentation -might have a MENTAL disability
what are intrauterine causes present at birth resulting in congenital cataracts? (5)
1. congenital rubella (measles) -> NC 2. intrauterine toxoplasmosis 3. CMV 4. opportunistic infection 5. maternal drug use (steroid, thalidomide)
what are the metabolic causes of cataracts?
1. diabetes 2. hypertension (medication) 3. galactosemia 4. galactokinase deficiency (from Graves disease) 5. Fabry's disease 6. Atopic dermatitis - really bad allergy; pts on long term steroid = PSC or stellate shaped cataract
what are lens size and shape abnormalities (3)?
1. lens coloboma - inferior nasal; associated iris coloboma; due to incomplete closure of embyonic fissure 2. microspherophakia - smaller diameter lens; spherical shape; opacification often present (ex: Weill Marchesani, Marfans - sometimes); bilateral, congenital 3. Lentiglobus - comparable to keratoconus; one specific area w/out-pouching of the lens; deformity of surface; conical, nipple-like
What is the #1 cause of cataracts causing a decrease in vision?
AGE
Lawrence-Moon-Biedl findings include: polydactyly, hypogonadism, retinitis pigmentosa, microcornea, iris coloboma & cataracts & MENTAL RETARD. Transmission?
AR
what is a pulverant cataract also known as?
Coppock's cataract or Doyne's discoid cataract
due to excessive heating of pre-lenticular iris; anterior capsule fibers "pull-off"/peel; may have weaker capsule or zonules
Exfoliation (true exfoliation is RARE - old furnace workers had this)
what is the surgical indication for Exfoliation?
Exfoliative glaucoma (lens fibers stuck in angle)
aka oculo-mandibulo-dyscephaly (bones of face/head not formed properly), nystagmus, microphthalmos, blue sclera, cognitive issues; not compatible w/life; BILATERAL CONGENITAL cataracts
Hallerman-Streif
hypermature cataract (cataract of any etiology that has reached advanced stages); imbibed water; whole cataract has progressed so fat that it begins to decompensate and cortical tissue LIQUEFIES so that the density of the lens sags; NUCLEUS DROPS out of center - poor VA
Intumescent
Arachnodactyly, skeletal abnormalities, slender bones, weak joints and connective tissue disorder; can be aortic/cardiac issues
Marfan's Syndrome
OLIGOPHRENIA (decreased development of the brain because the head is small - cranium space is limited) = MENTAL RETARDATION; cerebral ataxia, short stature, stabismus; BILATERAL CATARACTS
Marinesco-Sjogren's Syndrome
what is an intumescent cataract also known as?
Morgagnian type cataract
hypotonia w/wasting of musculature; facial diplegia, lacks expression, ptosis, chorioretinitis, retinal degeneration, cherry red macula, AD transmission & MENTAL RETARD
Myotonic Dystrophy
how does PS differ from PPM?
PPM is congenital
following a vitrectomy and other post seg procedures, what cataracts are commonly found due to oxidative stress and mechanical factors (gas tamponade or silicone oil)?
PSC initially then NS
Pseudo-exfoliation results in deposits in the anterior chamber - fine white substance. Associated w/?
Pigment dispersion Glaucoma - clog TM
mutation of the LOXL1 gene; synthesized from cells of CB, TM, iris, pre-equatorial lens; double ring appearance due to iris constricting and dilating between the two rings; anterior surface peels away (only superficial epithelial cells)
Pseudo-exfoliation
"peppercorn" presentation; small, dark, dense fetal opacity
Pulverant
associated w/small equatorial cortical opacities; look like isolated lines in the periphery; does not affect VA & will not progress
Riders
what type of cataracts present w/Wilson's disease?
SUNFLOWER
similar to an axial (Y-suture) opacity except that it is MUCH DENSER than an axial cataract; farther from fetal nucleus; does not change rapidly; lies along optic axis
Sutural cataract
mandibulofacial dysostosis (bad bone condition); AD; NO mental retardation; bird like faces; hearing loss; normal cognition
Treacher-Collins
how do cortical cataracts form?
UVB changes the H20 balance in the lens, causing a separation of fibers; opacities start as vacuoles and water clefts between lens fibers; begin inferiorly then progress
"inverted marfans" (short bones); brachydactyly (stubby fingers, short statue), ectopia lentis, spherophakia, microphakia (small lens), microcornea
Weill-Marchesani
hepatolenticular degeneration w/Kayser Fleischer ring in cornea; LIVER problems w/processing copper
Wilson's Disease
what should you look for w/concussive injuries?
angle recession; vossius ring (imprint of iris on lens - pigment deposition)
congenital absence of iris (iris root may or may not be present); associated w/lens deformity; can be associated w/glaucoma or albanism
aniridia
what cataracts are found with chronic anterior uveitis?
anterior and posterior subcapsular --> progress more quickly when found w/PS
In acute angle closure glaucoma (glaukomflecken), the acute spike in IOP causes a cataract where?
anterior lens capsule
anterior or posterior Y-suture opacity (not as dense as sutural cataracts); central lens - lies along the optic axis
axial cataract
how are cortical cataracts graded?
based on quadrants 25% = grade 1 50% = grade 2 75% = grade 3 100% = grade 4
opacity or cloudiness of the lens that may prevent a clear image from forming on the retina
cataract
cortical opacity; present in the far equator; speckled areas in lens peripher, bluish tint
cerulean
AR; associated w/skeletal abnormalities - malformation of cartilage, usually short stature & short life span; bones calcify near joints; BILATERAL CONGENITAL CATARACTS
chrondrodystrophia calcificans - congenital
What is the most common cause of secondary cataracts (result of other eye diseases)?
chronic anterior uveitis
1/3 of _______ cataracts are hereditary
congenital (pt was born w/it)
birth defect due to German Measles
congenital rubella
"crown-like" - stem w/a dot; present at equator; involves cortex; aka "blue dot" cataract
coronary
what is the most common lens opacity seen in clinical practice & the least clinically significant?
cortical cataracts
Toxic cataracts are caused by medications and enhanced by environmental factors (smoking, diet, alcohol, UV*). Ex of medications?
corticosteroids anti-psychotics phototherapy anti-neoplalstics anti-arrhythmias miotics RA meds
occur at any layer; similar to "christmas tree type"; usually unilateral; reflective and colorful; little effect on VA
crystalline cataract
FB makes contact w/lens
direct penetration (monitor - may have no effect on VA)
Lens Luxation due to:
dislocation of lens displacement of lens weakened/broken zonule fibers Marfans (superior luxation) Weill marchesani Trauma
high myopia can be associated w/posterior lens opacities & __________.
early nuclear sclerosis
What are the ocular problems associated w/Marfans?
ectopia lentis, lens subluxation
pupillary lens; pisciform (fish-tail shaped); little to no effect on acuity
epicapsular stars
what are two other capsular opacities (other than cataracts)?
epicapsular stars mittendorf dots (posterior capsule; deposition of PTVL)
other conditions causing cataracts?
hypocalcemia hypoparathyroidism albright's hereditary osteodystrophy pseudohypoparathyoidism
any opacity affecting any given lamella (layer) of the lens; DEVELOPMENTAL cataract --generic term
lamellar cataract
why pseudo-ex problematic for cataract surgery?
may have made zonules weaker = cataract surgery more challenging
What can result from lens luxation?
monocular diplopia RE shift VA shift
advanced lens changes can cause what kind of RE shift?
myopic - narrowing the anterior chamber
why is this cataract visually threatening?
near vision diminished more than distance (centrally located cataract); nodal point is critical
what type of cataract results from congenital rubella (15%)?
nuclear
changes occurring at the level of the nucleus; brunescent changes; relucent light;
nuclear cataract
Treacher-Collins presents w/what type of cataracts?
nuclear sclerosis
benign iris strands; can have any connection of the iris; visually significant if crosses pupil; prenatal reduction of the pupillary membrane
persistent pupillary membrane (PPM)
what must we worry about w/intumescent cataracts?
phacolytic glaucoma -> lens leaks, which causes inflammatory response and increased IOP = glaucoma; anterior chamber becomes shallow **IMMEDIATE ATTENTION needed
variable shapes; pigment deposition on the anterior lens surface or posterior cornea (Kruckenberg spindles on the endothelium); pigment in the angle; pseudoexfoliation syndrome
pigment dispersion
dense capsule opacity; anterior or posterior; can be AD; lies along the optic axis; due to toxic, electric, or traumatic
polar cataract
findings of LOWE's Syndrome (Lowe's oculo-cerebral-renal syndrome)? transmission (AR, AD, X)?
posterior lenticonus megalocornea bupthalmos dense bilateral cataracts; mother = punctate MENTAL RETARDATION X-LINKED
adhesion of posterior iris to the lens; can disrupt anterior capsule and cause cataracts; due to trauma or uveitis
posterior synechia
hereditary fundus dystrophies may result in early onset cataracts. Ex?
retinitis pigmentosa
a cataract associated w/a concussion -> anterior cortical (in cortex); petalloid appearance, not usually symptomatic
rosette cataract
what is a sutural cataract also known as?
stellate cataract
fibrous metaplasia of the anterior lens epithelium; posterior migration of epithelial cells
subcapsular cataracts
what kind of cataracts can Myotonic dystrophy cause?
subcapsular, cortical opacities polychromatic opacity (christmas tree cataract) spoke-like opacities in central lens (stellate - like)
most common cause of unilateral cataract especially in young
traumatic
specific type of lamellar cataract where a single layer is involved; metabolic etiology; not associated w/fibers
zonular cataract