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Phacogenic uveitis (phacoanaphylaxis): causes, symptoms, diagnosis, treatment
Last reviewed: 08.07.2025
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Phacogenic uveitis, phacoanaphylactic uveitis, is a rare granulomatous inflammatory process that develops when the immune system's tolerance to lens proteins is impaired, and is usually accompanied by hypotension. Phacogenic uveitis is often observed:
- after cataract extraction;
- traumatic rupture of the lens capsule;
- cataract extraction in one eye and subsequent cataract extraction or release of lens material in the case of mature cataract in the other eye.
[ Pathophysiology of phacogenic uveitis
It was assumed that phacogenic uveitis is a disease developing with immune rejection of previously sequestered lens proteins. However, lens proteins have also been found in the intraocular fluid of healthy eyes. Currently, it is believed that with phacogenic uveitis, the tolerance of the immune system to lens proteins is impaired, since phacogenic uveitis does not always develop with a rupture of the lens capsule. Cousins and Kraus-Mackiw suggest that phacogenic uveitis is a whole spectrum of diseases with autoimmune, infectious and toxic mechanisms of development. In humans, the autoimmune theory has not been proven, but in an experiment on rats, phacogenic granulomatous endophthalmitis was very similar to phacogenic uveitis. In animals sensitive to lens homogenate, surgical damage to the lens resulted in uveitis histologically similar to phacogenic uveitis. In the infectious mechanism, the inflammatory response develops to inactive bacteria, such as Propionibacterium acnes, found in the lens, or when bacteria provoke a violation of the immune tolerance of the eye. According to the lens toxicity theory, in the inflammatory reaction without prior immunization, the lens material has a direct inducing effect. These three theories may explain the development of phacogenic uveitis, but none of them has been proven. Unfortunately, phacogenic uveitis is often diagnosed after enucleation, when examining the histological material, when zonal granulomatous inflammation is determined with three populations of cells found around the lens substance:
- zone 1 - neutrophils tightly surrounding and infiltrating the lens;
- zone 2 - monocytes, macrophages, epithelioid cells and giant cells surrounding neutrophils;
- zone 3 - nonspecific infiltrate of mononuclear cells.
Symptoms of phacogenic uveitis
Patients complain of pain, decreased vision and redness of the eye.
Clinical examination
The onset of the disease varies, but most cases are characterized by a sluggish inflammation of the anterior segment of the eye, especially after surgical cataract extraction. The remaining lens substance is absorbed, and the inflammation is relieved. Panuveitis with hypopyon is a more serious manifestation of the disease, which is difficult to differentiate from endophthalmitis. The anamnesis usually indicates fragments of the lens remaining in the vitreous body. Granulomatous inflammatory reaction develops within a few days or months after the destruction of the lens. Phacogenic uveitis is usually accompanied by hypotension, sometimes an increase in intraocular pressure, and an increase in intraocular pressure is also possible. Precipitates are visible on the cornea, synechiae cause pupillary block or open-angle glaucoma.
Special tests
Aspirated aqueous humor or vitreous with negative bacterial cultures helps differentiate phacogenic uveitis from bacterial endophthalmitis. Cytology results are rarely useful. Ultrasound after cataract surgery or trauma can identify large lens fragments in the vitreous cavity.
Treatment of phacogenic uveitis
Continuous uveitis leads to phthisis if left untreated. The process is limited by the use of glucocorticoids locally and orally or by their introduction under the Tenon membrane. The final treatment is the removal of fragments of the lens, optimally with pars plana vitrectomy. Previously, the prognosis in severe cases of phacogenic uveitis was unfavorable, but at present, with modern surgical techniques and equipment, the possibility of maintaining good visual acuity is higher.