Introduction:

Ectopia Lentis or lens displacement, may be congenital, developmental or acquired, and the most common cause is trauma. Anterior displacement of the lens is an ophthalmological emergency, due to the risk of absolute pupillary block and irreversible corneal decompensation. Although the history of trauma is usually immediate or recent, it might have happened months or years before the luxation episode.

Case Report:

The authors report the case of a 50-year old female patient, presenting to the emergency department with a history of abrupt onset of ocular pain in the left eye, without a precipitating event, causing her to wake up from sleep. The patient also reported a progressive decrease of vision in that same eye, over the last few months. Her personal history was relevant for chronic alcoholism and benzodiazepine abuse, with previous emergency department (ED) visits for accidental trauma while intoxicated. The last visit to the ED had been 4 months before, with no record of direct eye trauma at that time or on any previous episode. Visual acuity was reduced to no light perception and examination was notable for anterior lens subluxation, with the nasal half of a mature cataract anteriorly displaced, causing a complete pupillary block. A concomitant exotropia of the left eye was also noted. IOP was 30mmHg at that time and a physical examination ruled out any recent trauma. The contralateral eye had no pathological findings, namely pseudo-exfoliation, phacodonesis or cataract. Ultrasound examination suggested a possible funnel-shaped fixed retinal detachment. The initial approach with cycloplegia failed to reposition the lens posteriorly due to its volume and hardness, thus prompting the authors to opt for an immediate intracapsular removal of the subluxated lens, through a superior 170º corneal incision, under general anesthesia. A complete retinal detachment was diagnosed intraoperatively and, considering the exotropia described and the absence of light perception, the patient was left aphakic and not considered a candidate for vitrectomy.

Discussion & Conclusions:

Anterior lens subluxation is a medical emergency, requiring urgent intervention. Though trauma is responsible for over half the cases, the history of trauma is not necessarily obvious or recent, and should be inquired in all cases. Concomitant retinal detachment should be ruled out in these patients.

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