A dislocated lens will frequently become cataractous and may give rise to attacks of glaucoma, iritis, etc.
PROGNOSIS-Congenital displacement, or ectopia lentis, usually occurs upward and inward, or upward and outward. It is often hereditary and usually remains unaltered. Other defects are frequently found with congenital dislocation. When the displacement is due to disease, the vision is as a rule vary bad and apt to grow worse. In traumatic cases the lens will usually become cataractous. Severe inflammation and glaucoma is apt to occur from a displacement into the anterior chamber.
TREATMENT-If the dislocation is forward into the anterior chamber, removal of the lens by a peripheral incision is a very simple affair. In some cases it is first necessary to transfix the lens with a needle to prevent it from slipping back through the pupil again. If the dislocation occur from a rupture of the sclera and it lies beneath the conjunctiva it is easily removed. If the lens remain clear and is but partially dislocated, it should be left alone and the most suitable glasses be prescribed. Dislocation of the lens backward into the vitreous is a much more serious affair. When it is of long standing and has caused no irritation of the eye, it may be left alone. If, however, it rests in the front part of the vitreous particularly, and there are signs of inflammation which may lead to destruction recommended by Knapp and Bull for the removal of lenses dislocated into the vitreous is, after thorough local anaesthesia, to make an upper corneal section and remove the speculum. the upper lid is now lifted away from the eyeball by the assistant, and through the lower lid pressure is made on the lower part of the eyeball and made directly backward. The lens will usually rise into the pupil and may come through the pupil and engage in the corneal wound, where the hook or spoon will usually become necessary to complete the removal. Failing to remove the lens by this procedure, or when the backward pressure causes an escape of the vitreous before the lens can be engaged in the wound, then the spoon or wire loop must be introduced into the vitreous and the lens extracted.
Dr. Agnew devised a double needle or bident which has been successfully used in a number of cases for the removal of the lens dislocated into the vitreous. It is used to fish up the lens and hold it from being pushed further backward by transfixing the globe about 6 mm. behind the cornea. The usual corneal section is then made and the lens extracted with the scoop, after which the bident is removed.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.