Congenital Ectopia Lentis

(A) Acquired
   –(a) Spontaneous due to excessive stretching of the zonules, as in buphthalmos, high myopia or perforation of corneal ulcer.Degeneration of the zonules, as in hypermature cataract , patients with latent syphilis.
    (b) Traumatic due to rupture of zonules following blunt or penetrating injury.

(B) Deliberate dislocation in the vitreous cavity by an ancient surgical procedure called couching.

Patients with Gyrate Atrophy are at risk for spontaneous dislocation of in-the-bag IOLs , most probably resulting from zonular disruption as has been described in some connective tissue disorders like Marfan,s syndrome, homocystinuria, and pseudophakic patients with poor cataract surgery.

Symptoms
1- Marked dimness of vision for distance and near due to high hypermetropia & loss of accommodation.
2- Slight improvement of vision in dislocated hypermature cataract.
3- Migration of the dislocated lens into the anterior chamber or vitreous, gives rise the symptoms of uveitis or glaucoma.

Signs
1-Signs of aphakia like deep anterior chamber,jet black pupil, iridodenesis and absence of 3 and 4 purkinjee images but without an iredectomy or a limbal scar mark.
2- When the lens is in anterior chamber and clear it appear as an oil globule due to total internal reflection.
3- In posterior dislocation after dilatation of the pupil, the lens can usually be seen translucent or opaque, lying at the bottom of vitreous.
4- In traumatic cases, associated ocular pathology may also be seen

During an eye examination an ophthalmologist looks for a lens that appears off center. In obvious cases this condition can be seen just by looking at the eye. Most often, however the ophthalmologists uses special eye drops to dilate pupil of the ye to see the lens behind it more clearly with the help of Slit Lamp .

A dislocated lens usually is not treated. The eye should be monitored by ophthalmologist periodically to make sure the condition remains stable .Blurry vision caused by dislocated lenses often can be corrected with glasses. If dislocation is accompanied by other problems or injuries such as cataract or retinal detachment it may be necessary to have surgery to remove the lens and replace it with a plastic lens.

In anterior dislocation – Immediate intracapsular extraction of the lens. In posterior dislocation – No inflammatory signs , dislocated lens is kept as such and only aphakic glasses are prescribed.

In presence of complications – the lens has to be extracted along with vitrectomy by various techniques.

Results may vary from patient to patient .Glasses may be needed to correct blurry vision from a dislocated lens. In some cases, the lens becomes cloudy overtime and may need to be replaced with a plastic lens implant. The ligaments that hold the lens in place do not heal or reattach .The condition is permanent.

1. Secondary Glaucoma
2. Severe Iridocyclitis.
3. Low grade cyclitis due to irritation of the ciliary body region by the lens.
4. Vitreo Retinal Degeneration.

The answer to this depends on the severity and strength of eye disease. Firstly consultation is required with an ophthalmologists and relevant follow ups visits as per his advise.

The expense depends upon the grades of treatment.