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Phacolytic Glaucoma

Acute lens-induced open-angle glaucoma caused by leakage of high-molecular-weight lens proteins from a hypermature (Morgagnian) cataract through an intact lens capsule, blocking trabecular outflow and causing severe IOP elevation.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Phacolytic Glaucoma?

Phacolytic glaucoma is a secondary open-angle glaucoma caused by leakage of denatured high-molecular-weight lens proteins from a hypermature (Morgagnian) or mature cataract through microscopic defects in an intact lens capsule. These proteins, along with macrophages engorged with lens material (so-called Flocculent or Hyperreflective particles), obstruct the trabecular meshwork.

The condition typically affects elderly patients with long-standing untreated cataract, often in countries with limited access to cataract surgery. Pathogenesis involves leakage of soluble lens proteins (>1000 kDa molecular weight) through capsular microleaks, followed by macrophage uptake; both proteins and protein-laden macrophages mechanically block aqueous outflow through trabecular meshwork.

Treatment requires urgent IOP lowering (topical and systemic agents) followed by definitive cataract extraction, which is curative. Without surgery, the glaucoma persists and causes optic nerve damage. Modern phacoemulsification can be challenging due to dense brunescent or Morgagnian cataract; extracapsular cataract extraction may be preferred. IOL implantation is usually possible.

Symptoms

Acute severe eye pain, redness
Markedly blurred vision
Headache, nausea, vomiting (high IOP)
Halos around lights
Long-standing poor vision in affected eye
Visible mature/hypermature cataract

Risk Factors

Hypermature (Morgagnian) cataract
Mature dense brunescent cataract
Elderly age, female sex
Limited access to cataract surgery
Prior trauma to lens (capsular microleaks)
Pseudoexfoliation, prior intraocular surgery

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Acute severe eye pain with red eye
  • Sudden vision loss with known cataract
  • Headache, nausea with eye symptoms
  • Halos around lights
  • Long-standing untreated cataract with new symptoms
  • Family history of glaucoma with cataract

Treatment Methods

01
Slit lamp shows mature/hypermature cataract, anterior chamber particles, mild AC reaction
02
Gonioscopy shows open angle (differentiates from acute angle closure)
03
Acute IOP lowering: topical (timolol, brimonidine, dorzolamide), systemic (acetazolamide, mannitol)
04
Topical corticosteroid and cycloplegic for inflammation
05
Urgent definitive cataract extraction (extracapsular or phacoemulsification)
06
Intraocular lens (IOL) implantation if capsular support adequate
07
Postoperative IOP usually normalizes; long-term glaucoma medications rarely needed

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.