Elderly Woman With Eye Pain
Article Outline
A 78-year-old woman complained of pain in her eye after a fall. Visual acuity was 20/40 on the right and 20/200 on the left. Physical examination results were further remarkable for monocular diplopia. A laterally subluxed lens (black arrows) and trailing zonular fibers (red arrow) was directly visualized (Figure 1). A computed tomographic scan, which was ordered to exclude concomitant trauma, confirmed the finding of an anteriorly subluxed lens (Figure 2). Emergency ophthalmology consultation was obtained. Because there was no evidence of increased intraocular pressure, repair was deferred for elective basis.
Figure 1.
Laterally subluxed lens (black arrows) and trailing zonular fibers (red arrow).
Figure 2.
An orbital computed tomographic scan revealing an anteriorly and laterally subluxed lens. Used with permission of Barry Hahn, MD, Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY.
Diagnosis
Ectopia lentis. Ectopia lentis, most commonly caused by trauma, occurs as a result of a rupture of the zonular fibers.1 Common presenting symptoms include decreased vision, pain, accommodation loss, and monocular diplopia.2 Iridodonesis (iris tremulousness) or phacodonesis (lens tremulousness) may be observed. In the absence of trauma, hereditary/systemic disease (eg, Marfan's syndrome, homocysteinuria) should be considered.3
Treatment is dictated by the cause of the dislocation, location of the displaced lens, and presence of any eye injury.4 If the lens displaces into the anterior chamber, glaucoma may result. In this case, one may consider reclining the patient until the lens falls back into place and then applying pilocarpine. If glaucoma does develop, emergency iridotomy is indicated. Posterior displacement of the lens may cause uveitis and retinal damage. Under these circumstances, vitrectomy and lens extraction are necessary. For stable refractive errors, visual correction with glasses may be an option. All instances require emergency ophthalmologic consultation.5
References
- . Trauma to the globe and orbit. Emerg Med Clin North Am. 2008;26:97–123
- . Ectopia lentis. Survey Ophthalmol. 1982;27:143–160
- Ophthalmology. 2nd ed.. Philadelphia, PA: Mosby; 2004;
- Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed.. Philadelphia, PA: Mosby; 2006;
- . Approach to ophthalmologic emergencies. Med Clin North Am. 2006;90:305–328
For the diagnosis and teaching points, see page 481.
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PII: S0196-0644(08)00609-4
doi:10.1016/j.annemergmed.2008.03.017
© 2008 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
