Lens Dislocation

A 67 year old female with trauma due to a motor vehicle collision. What is the diagnosis? • Xray of the Week

Figure 1. Brain CT. What is the significant finding.

Figure 2.

Axial CT brain demonstrates a right posterior lens dislocation with the lens lying in the dependent portion of the vitreous humor (red arrow). Note the normal location of the left lens in the iris (green arrow).

Figure 3.

A: Sagittal CT image demonstrates the right posterior lens dislocation with the lens lying in the dependent portion of the vitreous humor inferiorly (red arrow).

B: Sagittal CT image demonstrates the normal location of the left lens in the iris (green arrow).

Discussion:

Lens dislocation, also referred to as ectopia lentils, is used to describe any cause of misalignment or displacement of the crystalline lens [1]. The most common cause of lens dislocation is blunt trauma, which accounts for over half of all cases of lens dislocations [2-5]. If bilateral systemic connective tissue disorders such as Marfan’s syndrome, Ehlers-Danlos syndrome, and homocystinuria [1-4] should be considered. Lens dislocation is also seen post-cataract surgery because of zonular dehiscence [1]. Lens dislocations can either be anterior or more commonly posterior. Anterior dislocations are considered an ophthalmological emergency because the dislocated lens interrupts the drainage of aqueous fluid which can lead to acute angle glaucoma [4-6]. Initial symptoms of lens dislocation include decreased visual acuity and diplopia.

CT is the most commonly used diagnostic modality in lens dislocation and can clearly show lens displacement [4]. The axial CT scan above demonstrates a right lens dislocation (Fig. 2). The sagittal reformatted images show the right lens subluxed posteriorly and inferolaterally (Fig. 3). Ultrasound has been shown to rapidly diagnose lens dislocation as it can visualize internal structures of the globe [2, 7]. When a lens dislocation is detected, urgent referral to ophthalmology is needed as most cases require surgical intervention. A dilated fundoscopic exam is needed to rule out a retinal detachment which is a dangerous complication that can lead to blindness [8]. Ophthalmologists can correct the issue by replacing, explanting, or re-positioning the lens. Follow up with patients is recommended because of possible complications such as retinal detachment and cataract development [5].

References:

1. Hoffman RS, Snyder ME, Devgan U, et al. Management of the subluxated crystalline lens. J Cataract Refract Surg. 2013;39(12):1904-1915. doi:10.1016/j.jcrs.2013.09.005

2. Arthur J, Schubert B, Topp SS. Traumatic ocular lens dislocation. Afr J Emerg Med. 2019;9(2):106-107. doi:10.1016/j.afjem.2019.01.001

3. Bass LJ, Potter JW. A case of spontaneous dislocated lenses. Am J Optom Physiol Opt. 1985;62(5):352-356. doi:10.1097/00006324-198505000-00009

4. Kubal WS. Imaging of orbital trauma. Radiographics. 2008;28(6):1729-1739. doi:10.1148/rg.286085523

5. Jarrett WH II. Dislocation of the lens. A study of 166 hospitalized cases. Arch Ophthalmol. 1967;78(3):289-296. doi:10.1001/archopht.1967.00980030291006

6. Jones WL. Traumatic injury to the lens. Optom Clin. 1991;1(2):125-142. https://pubmed.ncbi.nlm.nih.gov/1799823/

7. Lee S, Hayward A, Bellamkonda VR. Traumatic lens dislocation. Int J Emerg Med. 2015;8:16. Published 2015 May 27. doi:10.1186/s12245-015-0064-5

8. Nelson LB, Maumenee IH. Ectopia lentis. Surv Ophthalmol. 1982;27(3):143-160. doi:10.1016/0039-6257(82)90069-8

Austin Sanu is a 3rd year medical student at the New York Institute of Technology College of Osteopathic Medicine. He plans on pursuing a residency in Diagnostic Radiology. Austin discovered his passion for radiology during his clinical rotations and finds using imaging to diagnose patients very rewarding. During his medical school career, Austin is a clinic manager for NYITCOM’s Community Free Clinic in Central Islip, Old Westbury, and Harlem. This organization helps patients without insurance receive health care while letting medical students get hands on experience before clinical rotations. Austin graduated from the New York Institute of Technology in 2017 with a Bachelor of Science degree in Biology. Austin’s hobbies include weightlifting and playing sports, especially basketball.

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Kevin M. Rice, MD is the president of Global Radiology CME

Dr. Rice is a radiologist with Renaissance Imaging Medical Associates and is currently the Vice Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator.

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