Hello and welcome to Case of the Day. I’m Dr Crowley and today we’re gonna discuss a fairly rare and interesting case. Had a gentleman who came in a couple of days ago with severe pain in his eye, and it turns out that he’d had surgery a few months ago, or I think two or three months ago, for Cataract surgery. I guess the surgeon had difficulty with the surgery and actually had to put in a different type of implant than we usually put in.
There are two basic types of implants – that is, an implant that goes behind the pupil, where your own lens is located and held in place by this capsule. We cut an opening in front of the capsule and then remove the cloudy lens material and then the implant goes inside and right where your own lens is sitting prior. But I guess there were problems and difficulties with this capsule and the ligaments holding it in place that they were damaged or broke apart. And so this lens sits in front of the iris and goes from this angle over to this side and so that’s an anterior chamber intraocular lens versus this is a posterior chamber lens. So almost always we put in a posterior chamber lens.
What happened was, is that normally fluid is produced by this gland, the ciliary body, behind the pupil and iris. The fluid then goes in front of the lens, behind the iris, goes through your pupil, fills up the front of your eye and then exits to this hole in the Trabecular meshwork in the Schlemm’s Canal and then into a drainage channel into your venous or the veins.
What happens in this type of situation where you had what’s called Pupillary Block Glaucoma, where the pressure is very elevated, is that the fluid was coming through and trying to get through the pupil but the lens had blocked the fluid coming through. Now the iris is bulged up against this cornea except where the lens was located. Usually when this type of lens is put in where there’s an anterior chamber lens, there’s an opening made in the iris out here to the side so it’s like a safety valve. Some of the fluid can go through this little hole and get over to the drainage system where that would be making a long trip around.
Either inflammation in this gentleman’s eye blocked this little hole or maybe there was not one made because of the cloudy cornea did not, I could not see for sure whether there’s an opening anywhere around. But what we did yesterday was laser an opening to this iris so now we have a straight flow of fluid flow through and we bypassed going to the pupil and while I’m watching at the slit left by the laser, I can see actually the iris fall back to its normal position. He came in today with a pressure of 9 and everything back in it’s normal position. Still has some inflammation and swelling in his cornea from all of this, but this looks like the softest problem.
Pupillary Block is a rare form of Glaucoma and it is due to the block from the fluid flowing from behind the iris through the pupil and to the anterior chamber. Commonly, many, many years ago when surgery was done with this whole lens material is removed and then the vitreous jelly that fills the back of the eye would block the pupil and then you would get this Pupillary Block. But with Posterior Chamber Lenses being used, you almost never have that ever occur. There’s a rare case where it could, but basically, almost never occurs with a Posterior Chamber Lens.
Today we saw a patient with a different type of Glaucoma called Pupillary Block Glaucoma and it is treated sort of similar to what Angle Closure is done, where we laser an opening out to the side of the iris and that prevents the block from happening and takes care of the problem.
If you have any questions about Pupillary Block Glaucoma or any other question, you can contact us through the website. We’ll be happy to try to answer your questions. If not, may God bless you with healthy eyes and great vision.