Lens luxation is the term used to describe a shift of the lens in the eye. Trauma or a congenital defect causes it to shift into the anterior chamber or vitreous humor of the eye.
What is lens luxation?
A lens luxation describes either a partial or a complete displacement of the lens in the eye. In these cases, it shifts upward into the anterior chamber or backward into the vitreous. When only one lens is displaced, there is often an injury or trauma. If both eyes are affected, it is a malformation or a genetic predisposition. If the dislocation happens only partially, it is called subluxatio lentis or lens subluxation. If the lens shifts completely, it is called luxatio lentis or lens luxation in the medical field. Both types fall under the term lens ectopia (ectopia lentis). In the case of partial displacement in a mild form, there are usually no symptoms. In the case of complete displacement of the lens, a so-called “lens flutter” occurs in many cases due to the overstretching of the zonula fibers. In this case, the crystalline lens is abnormally mobile in the eye. The fibers that hold it in place, the zonula fibers, are either overstretched or already torn in this case. As a result, the affected person develops severe myopia.
Causes
There are several causes of lens luxation. Traumatic external impact, such as a blow, may be one reason the lens does not stay in place. Diseases of the eye such as glaucoma and cataracts can also cause the lens to shift. For example, in glaucoma, medically known as glaucoma, the pressure in the eye is so high that the lens is pushed forward. In cataracts, also known as cataract in medical terms, the lens becomes cloudy gray for various reasons. In advanced cases of the disease, this causes the lens to shrink, putting the zonular fibers under tension. If they now tear, the lens can shift in the eye. A tumor that occurs in the ciliary body can also affect the ciliary fibers, which in turn cannot hold the lens in place. Again, the lens may shift. In cases of genetic predisposition, which often affects both eyes, the suspension apparatus of the crystalline lenses is impaired by connective tissue or metabolic disorders. In Marfan syndrome, Weill-Marchesani syndrome, or homocystinuria, the zonular fibers are not appropriately developed for various reasons. Therefore, the suspension of the lenses on both eye bodies does not succeed optimally.
Typical symptoms, complaints, and signs
Mild displacements are often free of symptoms. The eye may water more than before, as evidenced by increased blinking. The eye may be red. The cornea, which is normally transparent, appears milky. In a more severe case, double vision is the result, which in medicine is called monocular double vision, if it occurs in only one eye. Another consequence is a sudden onset of extreme myopia. After a fist blow to the eye, an eye contusion, a so-called contusio bulbi, can occur, in which the lens shifts. This results in a so-called contusion rosette, in which a star-shaped opacity of the rings can be seen. Hemorrhage makes the eyeball appear red.
Diagnosis and course of the disease
When the eye is examined with the aid of a slit lamp, the blind spot may appear double. Likewise, the lens is reduced in size because the zonula fibers no longer succeed in pulling it appropriately taut. Thus, it appears rounded and performs tremors. If the lens has completely slipped, it can be found on the bottom of the vitreous body. In this case, no improvement occurs without surgery.
Complications
Lens luxation does not necessarily cause discomfort or lead to complications in every case. If the condition is very mild, there is usually no discomfort. However, the eyes may water more, so that there are various restrictions in everyday life. Furthermore, those affected not infrequently suffer from reddened eyes. Other visual complaints can also occur as a result of the lens luxation. Thus, many patients suffer from double vision or veil vision. Especially in children, development can be limited or delayed due to lens luxation.It is not uncommon for lens luxation to also lead to sudden visual complaints, causing patients to suffer from sudden myopia. Tremors are also common with this condition. Usually, lens luxation can be treated with the help of medication and eye drops. This does not cause any further discomfort. In the case of a tumor, it must be removed to prevent further complications. In most cases, the course of the disease is positive and no further complications occur. The life expectancy of the affected person is also not affected or reduced by the lens luxation.
When should one go to the doctor?
Lens luxation requires medical evaluation. Individuals who notice signs of glaucoma are best to consult an ophthalmologist promptly. Double vision as well as veil vision are also symptoms that need to be clarified. If the signs of the disease quickly become more pronounced, it is best to contact the emergency medical service. If in doubt, go to the clinic or doctor’s office with the symptoms. Lens luxation can be treated well with a visual aid. However, if the condition is diagnosed too late, serious vision problems can develop. Then there is also the risk that the affected person will go blind. For this reason, the first signs of ectopy should be clarified by a doctor. The condition often occurs in conjunction with Marfan syndrome or Ehlers-Dahlos syndrome. Hereditary bone malformations are also possible triggers, which are best clarified before the lens luxation develops. In the best case, this will prevent the ectopia. Treatment is performed by the ophthalmologist or the responsible specialist for the respective underlying condition.
Treatment and therapy
In the case of a traumatic impact in which the lens has shifted only slightly, the eye must heal and the ciliary muscle must recover. Pain medications can help make the impairment tolerable. Eye drops help the healing process by disinfecting it. If there is a slight shift for other reasons, glasses or contact lenses can already help with vision correction. If the lens is noticeably displaced or even completely gone from its usual environment, it must be removed with the help of surgery and replaced with a new, artificial one. These are made of plastic. They allow normal vision because they perform the same task as the natural lens. Especially in the case of glaucoma and cataract as well as a tumor, surgery is often the only way to restore or improve vision. During surgery, an incision is made in the sclera to gain access to the lens. The lens is then removed. The eye is irrigated and then medicated to ensure healing goes smoothly. A new lens is inserted and the wound is sutured. In many cases, this operation can be performed on an outpatient basis under local anesthesia, so that the patient can go home the same day. There he should rest and not strain the eyes for the first few days. Eye drops must be applied to the eye regularly. After one to two weeks, a final examination is performed.
Outlook and prognosis
Lens luxation has a favorable prognosis. In many affected individuals, no further treatment is necessary. The irregularities are so minor that there are no serious impairments in coping with daily life. In many cases, visual corrections are made or drug treatment is initiated. If the symptoms are severe, the irregularity can be corrected by surgery. If the operation proceeds without further complications, the patient is subsequently discharged from treatment as recovered. Control examinations should take place at regular intervals so that the visual acuity can be documented and a quick reaction can be made in case of changes. In some patients, the cause of the lens luxation is a tumor. In them, the prognosis is determined by the stage of the tumor. In the case of malignant tumor development and an advanced stage of the disease, metastases may form in the organism. In severe cases, the death of the affected person is imminent. The sooner the tumor can be diagnosed and treated, the better the long-term prospects of recovery.Nevertheless, there is a risk of suffering consequential damage or having long-term visual impairment certified. This development worsens the prognosis overall. The quality of life decreases and a restructuring of daily routines is necessary. This can lead to psychological and emotional distress.
Prevention
To prevent against lens luxation, it helps to regularly perceive a preventive examination at an ophthalmologist. There, diseases such as cataracts and glaucoma are detected in time. In case of impairments, this visit is also advisable.
Aftercare
The aftercare of a lens luxation depends in its exact expression on the type and severity of the disease. As a rule, it is the ophthalmologist who gives the patient the specific recommendations for action and also specifies the duration of their application. The success of the measures or the previous therapy may be checked again in several follow-up examinations. It is particularly important to avoid irritation of the eyes at all costs, and this is not only aftercare, but often also precaution with regard to a possible relapse. For the patient, this means, for example, protecting the eyes from bright sunlight by wearing suitable glasses, refraining from wearing contact lenses, and taking measures to moisten the eyes if recommended by the doctor. Follow-up care can sometimes involve changes in skin care. Harsh cleansers for the face, especially those containing alcohol, are not appropriate. Makeup should not be used if possible. When shampooing the hair, care should be taken to prevent surfactants from running into the eye. Solarium goers should only go into the cabin with sufficient protectionn, as it can bring the drying of the eyes by the blower and the excessive light additionally irritates the eyes.
This is what you can do yourself
In the case of lens luxation, the most important measure is to take care of the affected eye. The patient should expose the eye to as little sunlight and irritating substances as possible. Shampoo and other care products should also only be used in consultation with the doctor to avoid serious complications. However, if discomfort occurs in the eye area, the physician should be informed. If the course is positive, it is sufficient to keep the eye closed for a few days – this can be achieved, for example, with special eye patches – and possibly wear glasses. If the lens is severely displaced, a surgical procedure must be performed. After the operation, the patient should keep a diary of any abnormalities so that the doctor can optimally adjust the accompanying drug therapy. Even after surgery, the affected eye must initially be spared. Driving and working on the computer should be avoided for at least one week. In addition, the eye must be treated with eye drops. With the doctor’s approval, alternative remedies from natural medicine are permitted. After two weeks, the doctor must be visited again for a final examination.
