Pathophysiology:

• Phacolytic glaucoma results from inflammatory processes initiated by the leakage of lens material through a mature cataract capsule.

• Altered lens protein and inflammatory cells obstruct the trabecular meshwork, precipitating glaucoma.
   

Diagnosis:

• Recognize phacolytic glaucoma by symptoms of eye pain, photophobia, and severe conjunctival hyperemia, particularly in older individuals with pre-existing vision problems.

• Diagnosis involves observing prominent cell or particle accumulation in the anterior chamber, a flare reaction without keratic precipitates, corneal edema, elevated intraocular pressure, and evidence of a mature cataract.

• Pseudohypopyon may also be present, characterized by lens protein deposits layering in the inferior angle.

• Gonioscopy typically reveals an open anterior chamber angle.
   

Management:

• Initiate treatment with topical cycloplegia, steroids, and aqueous suppressants to alleviate inflammation and reduce intraocular pressure.

• The primary goal is to reduce inflammation and intraocular pressure promptly.

• Definitive treatment involves cataract extraction to address the underlying cause of phacolytic glaucoma.

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Pearls:

• Recognizing the unique clinical presentation of phacolytic glaucoma is essential for accurate diagnosis and timely intervention.

• Effective management strategies focus on reducing inflammation and intraocular pressure to prevent optic nerve damage and preserve vision.

• Cataract extraction offers definitive treatment and addresses the underlying cause of phacolytic glaucoma, improving outcomes and patient satisfaction.