Abstract
Lens-induced uveitis is an anterior and intermediate uveitis resulting from a localized inflammatory reaction to crystalline lens proteins. Triggering events include mature or hypermature cataract, retained lens materials after extracapsular cataract surgery, lens capsule rupture following blunt or penetrating trauma, and iatrogenic capsular rupture from glaucoma surgery or other intraocular procedures.
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Keywords
Overview
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Definition
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Anterior and intermediate uveitis resulting from a localized inflammatory reaction to crystalline lens proteins
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Triggering events include
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Mature or hypermature cataract
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Retained lens materials after extracapsular cataract surgery
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Lens capsule rupture following blunt or penetrating trauma
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Iatrogenic capsular rupture from glaucoma surgery or other intraocular procedures
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Symptoms
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Blurry vision
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Photophobia
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Pain
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Floaters
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Laterality
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Usually unilateral
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Course
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Hours to decades after the causative event
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Inflammation is persistent and may be severe until lens materials are extracted completely
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Left untreated, LIU is complicated by severe glaucoma as well as pupillary and cyclitic membrane formation that ultimately results in hypotony, retinal detachment, and phthisis bulbi
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Age of onset
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60–70 years
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Gender/race
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No gender or racial predilection
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Systemic association
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None
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Exam: Ocular
Anterior Segment
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Non-granulomatous or granulomatous inflammation, with abundant cells and flare
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Small KPs (early disease) that coalesce into mutton-fat KPs (late, severe disease)
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Residual lens material in the anterior or posterior chamber (may be visible only on gonioscopy)
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Mature or hypermature cataract
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Ragged or ruptured anterior lens capsule
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Hypopyon or pseudohypopyon (inflammatory cells mixed with lens material)
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Posterior synechiae
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Elevated IOP
Posterior Segment
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Vitritis is always present, though may be obscured by media opacity
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Retinal detachment may occur in severe, untreated cases as the result of cyclitic membrane formation and contraction
Exam: Systemic
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Signs of head or facial trauma
Imaging
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Anterior segment OCT or UBM
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Useful in detecting retained lens material especially when gonioscopy is obscured by dense AC reaction
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B-scan
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May reveal retained lens fragments in the posterior segment
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Laboratory and Radiographic Testing
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AC or vitreous tap
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Histologically characterized by zonal inflammation in and around the lens, consisting of lymphocytes, neutrophils, macrophages, epithelioid and giant cells
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Culture and PCR to exclude infectious masqueraders
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Differential Diagnosis
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Sympathetic ophthalmia
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Bilateral
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Panuveitis with frequent inflammatory relapses
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Infectious endophthalmitis (exogenous or postoperative)
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Exogenous
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Commonly Staphylococcus epidermidis
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Open globe or intraocular foreign body may be present
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Panuveitis
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Postoperative
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Acute : S. epidermidis, typically occurring 2–6 weeks postoperatively
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Chronic: Propionibacterium acnes, typically occurring 3 months postoperatively
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Vitritis is usually mild with a granulomatous anterior uveitis
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Retained lens material not typically found
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Glaucomatocyclitic crisis (Posner-Schlossman syndrome)
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Recurrent episodes of elevated IOP, mydriasis, corneal edema and low-grade AC reaction
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IOL-associated uveitis
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Unlikely with biocompatible, acrylic IOLs
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Uveitis-glaucoma-hyphema (UGH) syndrome
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Consider other causes of anterior/intermediate uveitis if removal of lens material does not result in resolution of inflammation
Treatment
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Steroid, cycloplegic, and glaucoma drops for immediate inflammatory and IOP control
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Surgical removal of retained lens material, either via limbal incision or pars plana vitrectomy, offers definitive cure
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If retained lens material is minimal and resorption is likely, observation and treatment with topical steroids until all lens material is resorbed may be sufficient
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Referral/Co-management
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None
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Ueberroth, J.A. (2021). Lens-Induced Uveitis. In: Foster, C.S., Anesi, S.D., Chang, P.Y. (eds) Uveitis. Springer, Cham. https://doi.org/10.1007/978-3-030-52974-1_13
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DOI: https://doi.org/10.1007/978-3-030-52974-1_13
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Publisher Name: Springer, Cham
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