Phacoanaphylactic uveitis

Phacoanaphylactic uveitis, also known as lens-induced granulomatous uveitis or phacoantigenic uveitis, is a rare inflammatory eye condition that occurs when lens proteins are released into the eye and trigger an immune response. This typically happens following trauma to the eye, cataract surgery, or spontaneous rupture of the lens capsule. The body's immune system recognizes the normally sequestered lens proteins as foreign, leading to a granulomatous inflammatory reaction within the eye. The condition primarily affects the uveal tract (the middle vascular layer of the eye, including the iris, ciliary body, and choroid). Key symptoms include eye pain, redness, decreased vision, photophobia (sensitivity to light), and the presence of inflammatory cells and flare in the anterior chamber of the eye. On histopathological examination, a characteristic zonal granulomatous inflammation centered around lens material is observed, with epithelioid cells, multinucleated giant cells, and polymorphonuclear leukocytes surrounding residual lens cortical material. The condition can affect one or both eyes, though it typically presents unilaterally in the eye where lens disruption occurred. In some cases, a sympathetic-like response may occur in the fellow eye. Treatment involves controlling the inflammatory response with topical and sometimes systemic corticosteroids, as well as cycloplegic agents to reduce pain and prevent posterior synechiae (adhesions between the iris and lens). Definitive treatment usually requires surgical removal of all remaining lens material, which eliminates the antigenic stimulus driving the immune response. If left untreated, phacoanaphylactic uveitis can lead to secondary glaucoma, cataract formation in the fellow eye, and permanent vision loss. Early recognition and prompt management are essential for preserving visual function.

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