LENS ANATOMY😊

LENS ANATOMY

• Shape: Biconvex

• Power: +16D to +19D

• Color: Transparent

• Embryological development: Starts on Day 27

• Layers (Superficial → Deep):
• Capsule
• Anterior epithelium
• Cortex
• Nucleus (oldest lens fibers)

• Refractive Power (D)
• = 1 / Focal Length

Lens Proteins:

• Water soluble (80%):
• Types
• α Crystallins:
• Largest crystallin (600kDa)
• Found in epithelium.
• Heat shock proteins.
• β Crystallins:
• Major portion (55%).
• γ Crystallins
• Carbamalysation of crystallins → Snowflake cataract
• HM 1 and 2

• Water insoluble (20%):
• Urea soluble
• Vimentin, Filensin, Phakinin:
• Beaded filament disruption → cataract
• Mnemonic: Vim packet fill cheythapo kannil veenu
• Urea insoluble
• MIP 26/Aquaporin 0:
• Maintains lens transparency.

Lens Metabolism

• Lens: Avascular

• Glucose Diffusion:
• Via Aqueous (90%).
• Via Vitreous (10%).

• Metabolic Pathways:
• Anaerobic glycolysis: >80%.
• Kreb’s cycle & HMP shunt: ~15%.
• Sorbitol pathway: <5%.

Sorbitol Pathway

• Normally inactive.

• Activated by hyperglycemia
1. T1DM > T2DM
2. Galactosemia

Tissues

• Aldose reductase + Sorbitol dehydrogenase present
• Liver, ovaries, seminal vesicles
• No accumulation of sorbitol
• Mnemonic: LOSe sorbitol

• Only aldose reductase
• Lens, Retina, Kidneys, Schwann cells (LRKS)
• Application
• Diabetes
• Sorbitol accumulation → Carbamylation of crystallins
• Snowflake Cataracts (Cortical cataract)
• Retinopathy
• Neuropathy
• Nephropathy
• Classical Galactosemia
• High galactose → Galactitol (via aldose reductase) → osmotic damage
• Oil drop cataract

CATARACT

• Definition:
• Gradual and painless loss of vision.
• Most common cause of blindness in India.

• Classification:
• Acquired:
• Metabolic.
• Traumatic.
• Complicated.
• Senile/Age-related.
• Congenital:
• Infantile.
• Developmental.

• All are posterior subscapular cataract except
• Cortical cataract
• Sunflower cataract
• Cuneiform cataract
• Cuuni () irikkunna Sunflower () in Court ()

Traumatic Cataract

Blunt trauma signs

• Eg; Contusion injury (Eg, tennis ball injury/fist injury):

Hyphema:

• M/c sign.

• Blood collection in AC.

• Bleeding from major arterial circle of iris, branch of anterior ciliary artery
• NOTE:
• Anterior ciliary artery
• anterior segment of the eye
• conjunctiva, sclera, and iris
• Posterior ciliary artery
• posterior segment of the eye
• choroid and retina

Iris signs:

• Iridodonesis (trembling iris).

• Iridodialysis (detachment of iris root from ciliary body):
• D-shaped pupil.
• Diplopia → Due to light entering through centre and periphery
• Eg; Boxing or trauma
• Mnemonic: Donesis → Don varumbo tremble
• Phacodonesis
• Iridodonesis

Lens signs:

• Phacodonesis (trembling lens).

• Rosette shaped cataract (posterior subcapsular).

• Vossius ring (pupil pigment striking lens).

• Ectopia lentis (subluxation of lens)

• Mnemonic: Hifi kodukkathjond vassu (Vossius) commotio ondakki → Berlin (Berlins edema) nte mugath adichu → RIP → Rose (Rosette) vachu

Fundus/Retinal signs:

1. Cherry red spot at macula:



• aka Berlin’s edema
• Fluid accumulation in retina except macula in trauma
• Bcz Macula does not have ganglion cell layer
• Cherry red spot at macula -
• Mnemonic: Cherry Trees Never Grow Tall in Sand, Mud & Grime:
• CRAO
• Trauma (Blunt)
• Niemann-Pick disease
• GM1 gangliosidoses
• GM2 gangliosidoses
• Tay-Sachs disease
• Sandhoff’s disease
• Metachromatic leukodystrophy
• Multiple sulfatase deficiency
• Gaucher’s disease (Type 2 only)
• Least common
• Mnemonic:
• Cherry spot → Berlin picked () a sac () full of sand () → crawled (CRAO) and beat the retina (trauma) → Won game (GM1)

2. Retinal Detachment:
• M/c rhegmatogenous RD.

3. Commotio retinae (pale fundus).

4. Traumatic optic neuropathy:
• Causes 1° optic atrophy.

5. Vitreous hemorrhage:
• M/c cause of vitreous hemorrhage in young adults is blunt trauma

6. 2° open angle glaucoma:
• Angle recession glaucoma.
• Ghost cell glaucoma.

Fracture floor of Orbit

• Known as Blow-out fracture.

• Blunt Trauma to Orbit

• Occurs due to tennis ball injury (trauma direct to orbit)

• Orbit contents may herniate into maxillary sinus.

• Floor is more susceptible than medial wall.

• Radiological sign: Teardrop sign.

• Infraorbital nerve is involved.

• Other symptoms
• Enophthalmos (sunken eye)
• Diplopia on upward gaze
• Loss of sensitivity over the cheek

Corneal Foreign Body

Patient Presentation

• Metallic foreign body: In the cornea of the right eye.

• Symptoms: Pain, Redness, Potential Vision loss (if untreated).

Management Steps

• Removal Tool: 26 G needle.
• Chosen as it is very thin and least traumatic.

• Anesthesia: Topical eye drops.
• Example: Proparacaine eye drops.
• Onset of action: 20-30 seconds.
• Duration of action: 20 minutes.

• Removed under lamp.

Penetrating Ocular Trauma

Intra-Ocular Foreign Body (IOFB)

• Most common IOFB material: Iron, Steel.

Investigations for IOFB

• Note: 

Rings	Disease	Layer of Cornea
Kayser Fleischer ring	Wilson’s disease	• Copper in Descemet’s membrane
Fleischer's ring	Keratoconus	• Fe Deposition Basal epithelial layer
Pseudofleischers ring	Hypermetropia	ㅤ

Term	FB
Chalcosis	Copper FB
Siderosis	Iron FB

• Hudson nte stallil () Iron bulb ()

• Stock () of teri ()

Siderosis Bulbi

• Hudson Sahli line

• Cause: Deposition of iron (from iron-containing IOFB).

• Manifestations:
• Deposition of rust ring on anterior capsule of lens.
• Hyperpigmentation of iris.
• Secondary open-angle glaucoma.

• Diagnosis: 
• Prussian blue reaction → Stains iron deposits.

Fuchs Terms	Notes
Fuchs heterochromia iridocyclitis	Chronic AU ⇒ • U/L Diffuse Iris atrophy + Heterochromia + Posterior SCC • Painless, No redness, No posterior synechiae Positive Amsler's Sign: ◦ Bleeding into Anterior chamber on paracentesis ◦ Without trauma to Iris/Angle ◦ D/t abnormal fragile Iris Stellate Keratin Precipitates ↳ Herpetic uveitis ↳ Toxoplasmosis ↳ Fuchs Heterochromia Iridocyclitis • Young stella → Fucked () by Toxic () Herpes () Guy
Dalens Fuchs	• Seen in Sympathetic ophthalmitis ↳ (granulomatous panuveitis) • Dalen Fucked Granny () sympathetically ()
Foster Fuchs	• In Pathological Myopia • Bleeding at macula • Fucking in Foster () home ↳ Blind child (Pathological myopia) ↳ Bled (Bleeding at macula)
Fuchs Endothelial dystrophy	• Cornea guttata: • Wart-like excrescences on posterior cornea • Fuck her Guts→ endothelial Stages • Stage 1: Central corneal guttata that spreads peripherally • Stage 2: Corneal oedema - beaten metal-like appearance • Stage 3: Bullous keratopathy • Stage 4: Subepithelial scarring and superficial vascularization

 

Enucleation vs Evisceration vs Exenteration

NOTE:

ㅤ	Waardenburg Syndrome
ㅤ	• White forehead • Piebaldism + • Dystopia canthorum • Cochlear deafness. • Heterochromia iridis. Bald (Piebald) ayittulla Wardernu (Wardenburg) Vote kodutha Aarada (Vogt Harada)
ㅤ	Vogt Koyanagi Harada (VKH) Syndrome:
CF	• Granulomatous Panuveitis
Age	• Third or fourth decade
Signs	• Sunset glow fundus • Perilimbal Vitilligo: Suiguira sign
3 Phases	1. Meningoencephalitic phase (Distinguished) 2. Uveitis and Choroiditis (Distinguished) 3. Leukoderma, poliosis, and alopecia
ㅤ	Sympathetic ophthalmitis
CF	• Granulomatous Panuveitis
Signs	• Retrolental Flare • Dalen Fuchs nodules
Pathology	ㅤ
↳ Exciting Eye	• Eye that sustains initial injury. • Penetrating Trauma • Affecting ciliary body
↳ Sympathizing Eye	• The fellow eye, not initially injured. • Develops after 2 weeks (>2 weeks) from initial trauma.
Treatment	• Steroids
Prevention	• Enucleation of the traumatic eye within 14 days

• Granulomatous Panuveitis seen in
• Sympathetic Ophthalmitis
• VKH syndrome

• Wardenberg syndrome

• Wartenburg sign
• Involuntary abduction of little finger at rest
• Loss of hypothenar function → Digiti minimi

• Wartenburg syndrome
• Radial cutaneous nerve
• Also called Cheiralgia paresthetica.
• Both Warts in Hand

---

Type	Cause
Posterior	• Lowe syndrome ↳ Oculo Cerebro Renal syndrome • Opacity at posterior capsule center
Anterior	SAW Spina bifida Alport syndrome Waardenburg syndrome

---

Fuchs Terms	Notes
Fuchs heterochromia iridocyclitis	Chronic AU ⇒ • U/L Diffuse Iris atrophy + Heterochromia + Posterior SCC • Painless, No redness, No posterior synechiae Positive Amsler's Sign: ◦ Bleeding into Anterior chamber on paracentesis ◦ Without trauma to Iris/Angle ◦ D/t abnormal fragile Iris Stellate Keratin Precipitates ↳ Herpetic uveitis ↳ Toxoplasmosis ↳ Fuchs Heterochromia Iridocyclitis • Young stella → Fucked () by Toxic () Herpes () Guy
Dalens Fuchs	• Seen in Sympathetic ophthalmitis ↳ (granulomatous panuveitis) • Dalen Fucked Granny () sympathetically ()
Foster Fuchs	• In Pathological Myopia • Bleeding at macula • Fucking in Foster () home ↳ Blind child (Pathological myopia) ↳ Bled (Bleeding at macula)
Fuchs Endothelial dystrophy	• Cornea guttata: • Wart-like excrescences on posterior cornea • Fuck her Guts→ endothelial Stages • Stage 1: Central corneal guttata that spreads peripherally • Stage 2: Corneal oedema - beaten metal-like appearance • Stage 3: Bullous keratopathy • Stage 4: Subepithelial scarring and superficial vascularization

 

Noxious stimulus:

• IR rays:
• True exfoliation of lens capsule.
• Glassblower’s cataract.

• Lightning/Electric shock:
• Anterior capsular opacities.

• Xray
• Posterior subcapsular cataract
• Xray → PA view → PSC

Complicated Cataract

Senile Cataract

• Age group: 50-70 years.

• Types: Nuclear, Cortical, Posterior subcapsular, Anterior subcapsular.

Immature senile cataract

• Partial opacification of lens.

• The cuneiform and cupuliform patterns of opacification

• Iris shadow is visible.

• Slit-lamp examination
• Shows areas of normal and cataractous cortex.

 

• Phacoemulsification: Extracapsular extraction

• Foldable PCIOL implantation

Nuclear Cataract

• Pathogenesis:
• Sclerosis of lens → increased refractive index.

• Clinical Features:
• Index myopia (near-sightedness).
• Second sight phenomenon (improved near vision).
• LOV (Day > Night):
• Due to central location.
• Xanthopsia
• yellow coloured vision due to discoloured lens

Cortical Cataract

Mnemonic: Koonu (cuneiform) → wedge shaped

Pathogenesis:

• Hydration of lens.

• Formation of water clefts & vacuoles (earliest change).

• Separation of lens fibers (lamellar separation).

• Formation of wedge-shaped opacities (cuneiform cataract):
• M/c inferonasally.

Swollen lens (intumescent cataract):

• M/c complication:
• Phacomorphic glaucoma.
• Secondary angle closure glaucoma

• During this stage, puncturing of swollen lens during CCC result in Argentinian flag sign

Cortex liquefied (Morgagnian/Hypermature cataract):

• M/c complication:
• Phacolytic glaucoma.
• Secondary open angle glaucoma

• Morgagnian - agniyil mungunna cataract

Posterior Subcapsular Cataract

• Causes - Mnemonic: MNC Repay GST:
• Umar () took steroids () on Christmas ()
• to take 17 year old NF () posteriorly
• Gave Rose () → Used Oil () → put in Xxx (X ray)
• Myotonic dystrophy → Christmas cataract
• Neurofibromatosis.
• Complicated cataract →UMAR
• Radiation (X-Rays)
• Galactosemia → Oil droplet cataract
• Steroids (Systemic).
• Trauma (Blunt) → Rosette shaped cataract
• Parathyroid tetany in adults (also cause anterior subscapular cataract)

• Clinical Features:
• Glare (M/c):
• Difficulty in driving at night.
• Maximum LOV
• Day → pupil constricted (miosis) → makes it worse.
• Near vision worse than far

• Note: Topical steroids can cause Glaucoma.

Anterior Subcapsular Cataract

• Rarest type.

• Causes - Mnemonic: AAACG:
• Acute Angle Closure Glaucoma
• Atopic dermatitis.
• Amiodarone.
• Chlorpromazine.
• Gold deposits.
• Parathyroid tetany may cause

Surgical Management of Cataract

Cataract surgery rate (CSR):

• Total cataract surgeries per million population

• Not a true rate
• measures surgeries, not incidence
• lacks time component & follow-up

• Target CSR: 3000 per million

• Indicator: Success of blindness control programs

Surgical Management of Cataract

1. ICCE (Intracapsular Cataract Extraction):

• Whole lens removed including capsule

• Not able to implant IOL

• No longer used as large incision is required

• Only indication now
• Subluxated lens
• Dislocated lens

2. ECCE (Extracapsular Cataract Extraction):

• Lens removed, excluding capsule

• Techniques of ECCE:
• Conventional ECCE:
• Limbus incision (7–8 mm).
• Small Incision Cataract Surgery (SICS):
• Sclera-corneal tunnel incision (5–6 mm).
• Phacoemulsification:
• Clear corneal incision (3–3.5 mm).
• Photodisruption with Piezoelectric material
• Piezoelectric crystal converts ultrasonic energy to mechanical energy.
• Mechanism: To and fro motion.
• Steps 
1. Side port incision
2. Staining the capsule + CCC (Trypan blue dye)
3. Main incision
4. Hydrodissection
• Fluid injected under anterior capsule
• Separates lens from capsular bag
• Facilitates rotation
5. Hydrodelineation
• Fluid injected between nucleus and epinucleus
• Separates nucleus from cortex
6. Nuclear fragmentation
7. Phacoemulsification
• Divide and conquer technique
• Removal of nucleus
8. Irrigation & aspiration
• Removal of cortical matter
9. IOL implantation
• MICS
• 1.8 mm
• Photodisruption with Piezoelectric material
• FLACS
• Latest technique.
• Principle: Photodisruption
• Use: Femto laser: Nd glass laser → 1054 nm
• Laser used for 2 steps
1. CCC
2. nuclear fragmentation.
• Mnemonic:
• Flack → Flash → adichapo Glass (Nd glass) vacchond → photo disrupt () ayipoi

Phacoemulsification:

FLACS (Femtosecond Laser Assisted Cataract Surgery):

Lasers:

Principle	Laser	Uses
Photocoagulation	ㅤ	• POAG, ROP, PDR = Retina Problems
ㅤ	• Nd: YAG (532 nm) ↳ Double frequency	• Proliferative DR → Panretinal photocoagulation • Laser trabeculoplasty
ㅤ	• Argon green (514 nm)	• Rx of POAG • AG → Argon Green
ㅤ	• SLT (532 nm)	• Prophylaxis in other eye in POAG
ㅤ	• Diode red laser	• Retinopathy Of Prematurity (ROP)
Photodisruption	Disrupt Yagam	ㅤ
ㅤ	• Nd-YAG/Nd-glass	• SMILE (Myopia surgery) • Flash (FLACS) adichapo • Cap (PCO) vach Smile (SMILE) • Glass (NdGlass) vachond photodirupt () ayi.
ㅤ	• Nd-glass 1054 nm	• FLACS (Cataract Sx) → 1054 nm ↳ Femtosecond Laser ↳ Used for 2 steps 1. CCC 2. Nuclear fragmentation.
ㅤ	• Nd-YAG 1064 nm	• Posterior Capsular Opacification (PCO) / ↳ After-cataract ↳ Occurs 6-12 months postop Cataract Sx ↳ M/c complication. ↳ Elschnig’s pearls (90%) ↳ Nd-YAG posterior capsulotomy / (Peripheral Iridotomy)
Photoablation	ㅤ	ㅤ
ㅤ	• Excimer	In Psoriasis • Targeted UVB (Phototherapy) • Xenon Chloride (308 nm) In LASIK, PRK for myopia • Argon & Fluoride (193nm) • Most commonly used in refractory surgeries

 

Intra-ocular lens (IOL) Types:

PCIOL (Posterior chamber IOL):

• Implanted in capsular bag.

• Better choice.

• In most cases,
• last a lifetime without causing any problems.

Biometry:

• Calculations of IOL power to be implanted.



1. Keratometry:
• Measures corneal curvature.

2. A scan USG:



• Measures Axial length or AP diameter of eye
• (Normal AL ~ 24 mm)
3. IOL power calculation:
• Using SRK-T formula.
• Mnemonic: Sharukan → Power

Formulas	For eyeball with	Mnemonics
SRK 2/T	• Longer axial length	Too long
SRK 1	• Normal axial length	Once normal
HOFFER Q	• Shorter axial length	Short Que
HAIGIS L	• Post Lasik / PRK patients	L for lasik

Complications of Cataract Surgery

Operative:

• Posterior Capsular Rupture (PCR).
• Intraocular lens will fall into vitreous humor

• Uveitis-Glaucoma-Hyphema (UGH) Syndrome
• due to iris chaffing by ACIOL

• Vitreous loss
• Most serious

• Expulsive choroidal hemorrhage:
• Bleeding from choroidal artery.

• Descemet membrane detachment:
• Reattached by injecting air bubble or gas in AC → Descemetopexy.

• Damage to superior rectus artery while passing bridle suture

Postoperative:

• Irvine Gass/Vitreous wick syndrome:
• 6-10 weeks postop.
• Small part of vitreous touch cornea
• Presents with Cystoid macular edema + bullous keratopathy.
• Mnemonic: Vitreous wick → gas (irvine gass) vach kathichu → Bullous (bullous keratopathy) and edema (cystoid macular edema) ayi

• Posterior capsular opacification (PCO) / After cataract
• M/c complication.
• Occurs 6-12 months postop.
• Types:
• Sommering’s ring (10%)
• Elschnig’s pearls (90%)
• Treatment: Nd YAG laser 1064 nm posterior capsulotomy.
• When Cataract surgery complicate → do yagam

• Retinal detachment.

• Displacement of IOL:
• Sunset syndrome (inferior subluxation).
• Sunrise syndrome (superior subluxation).
• Lost lens syndrome (complete dislocation).

• Toxic Anterior Segment Syndrome (TASS).

• Flat/shallow AC:
• Wound leak.
• Ciliary choroidal detachment.
• Pupillary block glaucoma.

Congenital rubella syndrome.

• Risk of transmission ↑↑↑ → if earliest before 11 weeks of gestation

• Least r/o perinatal transmission

• Virus excretion → saliva, urine

• Mnemonic : Rubee → Blue bee( Blueberry rash)
• Sitting in salt and pepper (Salt & Pepper Fundus)
• Shiny Pearly eyes → Nuclear pearly cataract
• Can't see (Small eyes) can't hear (SNHL) also had some heart disease.
• adich Padam (PDA) aakki

• Triad of Gregg
• PDA
• Cataract
• SNHL

Complications

1. Congenital heart diseases:
• Most common: Patent Ductus Arteriosus > PS
• Least common: Atrial Septal Defect.

2. Sensorineural hearing loss.

3. Blueberry muffin lesion:
• Bluish red nodular lesions
• characteristic of congenital rubella.

4. Microcephaly, IUGR.

5. Glaucoma.

6. Hepatosplenomegaly.

7. Jaundice.

8. Thrombocytopenia.

Key Ocular Manifestations:

• Congenital nuclear cataract
• Nuclear Pearly Cataract
• Most common cataract in CRS

• Micro-ophthalmos
• abnormally small eyes

• Salt & Pepper Retinopathy

NOTE:

• Salt & Pepper Fundus



• Mnemonic: Salt and pepper movie
• Ruby (Rubella) → a Star (Stargardts)
• Rough (Refsum) Labor (Lebers) who has Syphillis (CS) Raped (RP → Retinitis Pigmentosa) her → got Rid (Thioridazine) of body
• Thio Ridazine :
• Thio Ridazine → rid of
• Brown (Brown vision) Cuteee (QT prolongation) with colorful eyes (RP),
• like Salt and Pepper () movie
• but ejaculated retrograde ()

• Diagnosed by:
• Presence of IgM rubella antibodies in the infant shortly after birth
  (since IgM does not cross the placenta)
• Persistence of IgG antibodies for >6 months
  (maternally derived antibody would have disappeared)

Endophthalmitis

• Definition: Suppurative inflammation of all structures except sclera.

Endophthalmitis Causes:

• Early postop (<7 days): 
• CoNS (Staphylococcus epidermidis).
• Mnemonic: < 7 days → hospital staff responsible (Staph)

• Late postop (≥6 weeks): 
• Propionibacterium.
• Mnemonic: No proper care (Propioni) after 6 weeks

• Traumatic: 
• B. cereus.
• Mnemonic: traumatic → keeripoi (Cereus)

• Endogenous:
• Klebsiella, Candida.

Clinical Features:

• Pain, Redness.

• LOV.

• Signs
• Congestion
• Hazy cornea
• Hypopyon
• Vitritis.

Treatment:

• Mnemonic:
• hand motion - hand tap
• light perception - light on a plane (pars plana vitrectomy)
• nothing - leave nothing except sclera

Note:

• Systemic antibiotics have no role.

Congenital Cataract

• Treatment:
• Immediate surgery for infantile cataract.

• Mnemonic:
• Blue → A/w congenital
• dot → Cataract
• Dot → Downs → Developmental
• eyes → glaucoma
• Dvelopmental Cataract → Developed cat/ mitten (mittendorf) → Post (Posterior polar) ayapo onion (onion) thinnu

Infantile Primary Congenital Cataract (IPCC)

• Onset & Presentation:
• At birth (no progression).
• Identified within 1 year.

• Symptoms:
• Severe vision loss.
• Causes:
• Fixation failure leading to sensory deprivation amblyopia.

• Management:
• Surgery upon diagnosis (ideally within 1-2 weeks).

• Lamellar / Zonular Cataract
• Most Common
• Autosomal dominant
• A/w:
• Congenital Rubella Syndrome.
• Vitamin D deficiency.
• Appearance:
• Spoke-like opacities
• Riders
• Opacity in fetal nucleus.

Developmental Cataract

• Onset & Presentation:
• At birth (no progression).
• Identified after 1 year of age.

• Symptoms:
• Minimal vision loss.

• Management:
• Wait & watch approach.

• Common Types / Associations:
• Blue-dot Cataract (Most Common).
• Associated with Down Syndrome.
• Posterior Polar Cataract.
• Associated with:
• Mittendorf dots.
• Remnants of anterior end of hyaloid artery / tunica vasculosa lentis.
• Bergmeister papilla
• Remnants of posterior end of hyaloid artery
• Persistent Hyperplastic Primary Vitreous (PHPV).

• Appearance:
• Onion ring / whorled appearance.
• Blue dots.
• Posterior capsule or anterior capsule involvement.

Treatment Principles

• Lens Aspiration (for Soft Lenses) +

• posterior capsulorhexis +

• Anterior Vitrectomy (to avoid mixing of aqueous and vitreous humors)

• IOL Implantation
• Done >2 yrs of age
• Small IOLs implanted in infants (<1 year) may lead to lens dislocation later.
• This is due to significant increase in eyeball size as the child grows.

• IOL Undercorrection required as power ↑↑ by age:
• 20% for children < 2 years old.
• 10% for children 2-8 years old.

• Pediatric pseudophakia
• Implantation of IOL in a child

Miscellaneous Lens Disorders

Ectopia Lentis

• Subluxation of lens due to breakage of zonules.

• Clinical Features:
• Diplopia → due to differential refractive power

Lenticonus

Type	Cause
Posterior	• Lowe syndrome ↳ Oculo Cerebro Renal syndrome • Opacity at posterior capsule center
Anterior	SAW Spina bifida Alport syndrome Waardenburg syndrome