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Ocular lens displacement


Key points

  • Definition: Ocular lens displacement (OLD) refers to the malposition of the lens relative to its normal location as a result of disruption of the zonular fibers, which normally connect the lens to the ciliary body.

  • Synonyms: Lens luxation, lens subluxation, dislocation of lens, ectopia lentis .

  • Classic clue: The patient presents posttrauma with visual disturbance, monocular diplopia, reduced visual acuity, reduced near vision, and painful red eye. Imaging shows the lens to be displaced from its normal location.

  • In the absence of trauma, lens dislocation should raise suspicion of hereditary systemic or ocular disease.

  • Complete lens dislocation is termed lens luxation (see Figure 6-1 ).

    FIGURE 6-1 ■, Ocular lens displacement. Axial non-enhanced computed tomography through orbits revealing heterogeneously calcified cataract located in the dependent portion of left vitreous chamber. The opposite lens was in the normal position but on a different image slice.

  • Incomplete luxation is termed lens subluxation (see Figure 6-2 ).

    FIGURE 6-2 ■, A, Recent trauma to OS showing soft tissue swelling, posterior lens subluxation, and high-attenuation retrobulbarr hemorrhage. B, Nonenhanced computed tomography in different patient showing normal position of left lens for comparison.

  • Dislocation involves total detachment of the zonules, permitting free lens movement.

  • Subluxation is suggested by lens movement in any direction, and involves continued attachment to the ciliary body by some intact zonules.

Imaging

Computed tomography features

  • Computed tomography can clearly depict the lens position and is frequently used in acute-trauma situations.

  • It is necessary to review a cut through plane of the lens.

Magnetic resonance imaging features

  • Magnetic resonance imaging can clearly depict the lens position in multiple planes.

Ultrasound features

  • Ultrasound can demonstrate the anatomic position of the lens but may be contraindicated in certain trauma situations, particularly when perforation is present or suspected.

Clinical issues

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