Lens-Induced and Secondary Glaucomas: Phacomorphic, Phacolytic, Neovascular and More
Last updated: November 2026
In India, the lens is one of the commonest causes of an acutely painful high-pressure eye, because mature cataracts are left untreated. Recognising which secondary glaucoma you face tells you what will actually fix it, usually something more than pressure drops.
Lens-induced glaucomas
| Type | Mechanism | Clues | Definitive treatment |
|---|---|---|---|
| Phacomorphic | Swollen (intumescent) lens pushes the iris forward: secondary angle closure | Shallow AC in the affected eye only, mature cataract, fellow eye deep | Lower IOP, then cataract surgery (often SICS or phaco with care) |
| Phacolytic | Leaking lens proteins block the trabecular meshwork; angle open | Hypermature (morgagnian) cataract, deep AC, white flocculent cells, no KPs | Cataract extraction |
| Lens particle | Retained cortex after surgery or trauma | White fluffy material in AC | Remove the lens matter |
| Phacoanaphylactic (phacoantigenic) | Granulomatous reaction to lens protein after capsule breach | KPs, uveitis weeks after trauma or surgery | Remove lens material, steroids |
| Ectopia lentis | Subluxed or dislocated lens causing pupil block | Marfan, homocystinuria, trauma, pseudoexfoliation | Laser iridotomy, lens removal |
Other secondary glaucomas
| Type | Key points |
|---|---|
| Neovascular | Ischaemia (PDR, CRVO, ocular ischaemic syndrome) drives iris and angle new vessels. Anti-VEGF, PRP, IOP drugs; tube or cyclophotocoagulation. |
| Uveitic | Inflammation or synechial closure (Posner-Schlossman, Fuchs heterochromic, herpetic). Control inflammation; avoid prostaglandins in active uveitis if possible. |
| Steroid-induced | IOP rise in weeks of steroid use, more in children and high myopes. Stop or reduce the steroid; can need surgery. |
| Pseudoexfoliation | White flaky material on the lens and pupil, high IOP spikes, weak zonules. Faster progression than POAG; plan cataract surgery carefully. |
| Pigmentary | Young myopic men, Krukenberg spindle, radial transillumination defects, heavy angle pigment. |
| Traumatic and angle recession | Hyphaema, angle recession on gonioscopy: lifelong risk; check IOP yearly. |
Where residents slip
- Treating phacomorphic or phacolytic glaucoma with drops alone: the lens must come out.
- Missing neovascularisation of the angle: gonioscopy before dilation.
- Forgetting steroids as the cause of high IOP in a VKC child.
Test yourself: flip cards
Related: Angle Closure Glaucoma Definitions, Pseudoexfoliation Syndrome and Glaucoma, Glaucoma.
Key sources
- European Glaucoma Society. Terminology and Guidelines for Glaucoma, 5th edition. 2020
- Papaconstantinou D, et al. Lens-induced glaucoma in the elderly. Clin Interv Aging. 2009;4:331-336
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