Let's Not Forget Phacoanaphylactic Endophthalmitis

Abstract

Summary Over the last 6 years we have accumulated 20 cases of phacoanaphylactic endophthalmitis (PAE) — 9 following trauma, 6 following surgical procedures and 5 with no previous history of trauma or surgical intervention. This includes 2 cases of animal eyes referred to the Pathology Department for diagnosis. PAE is usually a unilateral, zonal, anterior granulomatous inflammation following injury to the lens of one eye. It is thought to be the result of autosensitization to lens protein, liberated in its native state through a ruptured capsule and acting as an antigen. Of our 20 cases, 19 were enucleations and one was a corneal disc. PAE was considered in the clinical differential diagnosis in only one case. The aim of this paper is firstly to draw attention to PAE in the differential diagnosis of endophthalmitis, as it is a treatable condition if diagnosed early and, secondly, to consider whether there is room for less conservatism in patients with penetrating eye injuries if there is evidence of lens damage at the time of the primary surgical repair.