gms | German Medical Science

A ciliolenticular block is characterized by a rise in IOP and a shallow anterior chamber. This problem is a known complication after fistulating or other intraocular surgery and is also called malignant glaucoma. We report a case of spontaneous ciliolenticular block with a sudden increase in refractive error.

A 34-year-old male patient was referred to our department with acute loss of visual acuity in the left eye. Ophthalmological history and investigations were performed including visual acuity, objective and subjective refraction, slit lamp examination, tonometry, fundoscopy, visual fields, axial length and compartment measurement and ultrasound-biomicroscopy.

The left anterior chamber was shallow, but no other abnormalities were found by slit lamp investigation. Intra-ocular pressure was raised to 20 mmHg in the left eye (right 12 mmHg). The cornea-lens distance (CLD) was decreased to 1.9 mm in the left eye (3.1 mm right eye). The refractive error was -5.0 dpt (before loss of visual acuity -0.25 dpt). No abnormalities were found in the right eye. Nd:YAG-laser iridotomy was performed and the pupil was dilated for 10 days in the left eye, which decreased the intraocular pressure to normal levels and restored normal CLD. After 5 week follow up the CLD was 2.9 mm and the refraction -0.5 dpt.

A spontaneous high refractive error and visual loss, especially in one eye, can be caused by a ciliolenticular block. Comparing the CLD in both eyes may give an important clue in finding the correct diagnosis. In combination with medical therapy, Nd:YAG-laser iridotomy should be performed initially to achieve normal refraction and aqueous circulation.