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ECTOPIA LENTISRAMA
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!
Displacement of the lens from its normal position
(in patellar fossa) results from partial or complete
rupture of the lens zonules.
Positioned just posterior to the iris and is
supported by zonular fibers arising from the
ciliary body.
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CLINICO-
ETIOLOGICAL
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Clinico-Etiological Types
Ectopia Lentis
Hereditary
w/ Systemic
w/o Systemic
Acquired
Traumatic
Consecutive/Spontaneous
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Without Systemic
AssociationsFamilial Ectopia LentisBilaterally symmetrical
superotemporal
AD fashion
Ectopia lentis et pupillae
Pupil and lens in opposite
directions
Small, slit-like, and dilate-poorly
pupil
Aniridia
Absence of iris
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With Systemic Associations
Marfan Syndrome
AD
Bilaterally symmetrical
superotemporal subluxation (80%)
Dislocation into anterior chamber or
vitreous (20%)
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With Systemic Associations
Homocystinuria:
AR, inborn error of metabolism
Inferonasal
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Traumatic displacement of the
lensAssociated with concussion injuries.Couchingis an iatrogenic posterior dislocation of
lens performed as a treatment of cataract in
olden days.
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Consecutive or spontaneous
displacement
Intraocular diseases giving rise to mechanical
stretching, inflammatory disintegration or
degeneration of the zonules.
Hypermature cataract, buphthalmos, highmyopia, staphyloma, intraocular tumours and
uveitis.
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TOPOGRAPHICAL
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Subluxation
Partial displacement in which lens is moved
sideways (up, down, medially or laterally), but
remains behind the pupil.
Partial rupture or unequal stretching of thezonules.
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Subluxation
Clinical Features
Defective vision
Uniocular diplopia
Anterior Chamberdeep and irregular
Iridodonesis
Dark Edge
Complications
Refractive error
Complete dislocation
Cataractous changesUveitis
Secondary glaucoma
Management
Spectacles/contactlenses
Surgery
Lensectomy with
anterior vitrectomy
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LuxationAll the zonules are severed from the lens.
A dislocated lens may be incarcerated into the
pupil or present in the anterior chamber, the
vitreous (where it may be floating lens nutans;
or fixed to retina
lens fixata), sub-retinal space,subscleral space or extruded out of the globe,
partially or completely.
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LuxationClinical Features
Posterior: deep anterior
chamber, aphakia in
pupillary area, and
iridodonesis.Ophtalmoscopic
examination reveals lens
in the vitreous cavity.
Anterior: deep anteriorchamber and presence of
lens in the anterior
chamber.
Clear lens looks like an oil
drop in the aqueous.
Complications
Uveitis
Secondary glaucoma
ManagementAnterior: ASAP!
Posterior: if only
causing uveitis or
uncontrolledglaucoma
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Khurana, Comprehensive Ophtalmology 4th Edition (Step by Step)
Vaughn and Asburys, General Ophtalmology 17th Edition
Kanski, Clinical Ophtalmology
DANK U WEL