Lens dislocation – how can I tell if my lens has slipped out of place?

Lens dislocation, medically known as luxatio lentis, is an eye condition in which the lens becomes detached and displaced from its natural position. By obstructing the flow of aqueous humor, this condition can quickly lead to a dangerous increase in intraocular pressure. If not treated in time, it can result in blindness.

INHALT
Anatomy and development Cause Symptoms Diagnosis Treatment Forecast
Anatomy and development

Together with the cornea and the vitreous body, the lens is one of the transparent structures of the eye that are responsible for refracting and focusing light. The lens is surrounded by a transparent lens capsule and attached all around by the so-called zonular fibers (= holding threads) between the iris (= rainbow membrane) and the vitreous body. If these fibers tear, the lens detaches from its position and can move freely within the eye. In most cases, the lens slides forward in the eye between the iris and the cornea, blocking the chamber angle and thus the outflow of aqueous humor.

Schematic diagram of lens dislocation
1 Iris | 2 Torn zonular fibers | 3 Lens with capsule displaced into the anterior chamber | 4 Intact zonular fibers | 5 Ciliary body
Cause

Lens luxation can have various causes. A basic distinction can be made between primary and secondary lens luxation. Primary lens luxation (PLL) is caused by a hereditary defect in the zonular fibers. The supporting fibers are defective and cannot withstand the natural strain over time. Terrier breeds such as Jack Russell Terriers, Welsh Terriers, Jagdterriers, and Miniature Bull Terriers are particularly affected. Dogs develop the condition between the ages of three and six, and both eyes are usually affected. Secondary lens luxation (SLL) occurs as a result of an underlying eye disease. These include inflammation of the iris, severe eye injuries, cataracts (see text), glaucoma (see text), or tumors of the eye.

Symptoms

In primary lens luxation, the initial symptoms are often very subtle and therefore not always easy for the owner to recognize. There is often increased tearing and slight reddening of the eye. The animals blink more frequently or squint, and a milky cloudiness of the cornea may be observed. These initial acute symptoms may disappear after a few days, leaving the eye looking largely normal, which is why the condition is sometimes misdiagnosed.

As the disease progresses, the increase in intraocular pressure causes severe pain, which the animal clearly shows by trying to rub or scratch the affected eye. The eye waters profusely, the eyeball is enlarged, and the pupil is dilated and no longer reacts to light. The eye is very sensitive and painful, and the conjunctiva is severely reddened. The animals are often also disturbed in their general well-being, they eat less and are significantly quieter. Primary lens luxation usually occurs bilaterally, with one eye being affected first and the second eye following shortly thereafter.

Secondary lens luxation is often diagnosed very late, as the symptoms of the underlying disease are more prominent. In many cases, the eye is already blind at the time of diagnosis, so treatment is limited to pain management.

Diagnosis

A lens dislocation is always an acute emergency that must be treated as quickly as possible. If you notice any of the symptoms described above in your pet, please take it to a veterinarian immediately. After a thorough examination of the animal in conjunction with a detailed preliminary report, the veterinarian can usually make a preliminary diagnosis. This suspicion can be confirmed with the help of a special eye examination.

Treatment

Depending on the cause, duration, and progression of the disease, different treatment measures may be used. The treating veterinarian will usually treat the affected eye with eye ointments or drops at the beginning to reduce the acute inflammation in the eye, lower the intraocular pressure, and thus relieve the severe pain. In addition, the eye is prepared for possible surgery.

In cases of acute symptoms and primary lens luxation forward, emergency surgery may be performed within the first 48 hours. This involves opening the eye under a surgical microscope through a large incision in the cornea, allowing the lens to be removed. If this surgical procedure is performed too late, irreversible damage or even blindness may result. The eye is severely traumatized by the relatively large incision in the cornea, which can lead to complications such as retinal detachment, bleeding into the eye, inflammation, or increased intraocular pressure.

The eye is still very sensitive after such a surgical procedure and must therefore continue to be treated with special eye ointments or drops. To prevent the animal from scratching its eye, a neck collar must be worn. The patient should not romp or play wildly for the first two weeks after the operation. Another surgical method is to use ultrasound to break up the lens inside the capsule. This method has the great advantage of being much less invasive and requiring only two small incisions in the eye. However, it can only be used for partially dislocated lenses, as is often the case with the partner eye.

In cases of secondary lens luxation, the underlying disease should be diagnosed and treated first. Depending on the findings and prognosis, your veterinarian will discuss further treatment with you.

In animals that cannot or should not undergo surgery, lifelong administration of special eye drops can narrow the pupil, which stabilizes the detached lens behind the iris in the vitreous chamber. However, the success of this treatment depends on consistent administration of the eye drops, as the pupil quickly dilates again without the medication and the lens can then slip forward and block the flow of aqueous humor.

Forecast

The prognosis for lens dislocation depends on the time of diagnosis, the duration of the condition, and the success of any surgery. After surgical removal of the lens, the prognosis is favorable as long as no complications arise. Nearly half of all patients who undergo surgery still have good vision 2.5 years after the operation. The best prognosis is for animals whose lenses are removed using ultrasound fragmentation. In these cases, 75% of all patients who undergo surgery still have vision after 2.5 years.