Chronic uveal traumatization syndrome: a complete description of symptoms

Currently, the long-term effects of phacoemulsification with intraocular lens implantation, including uncomplicated, are more frequently identified. Uveitis–glaucoma–hyphema syndrome, also known as Ellingson syndrome, is one of these complications, but the names cannot reflect its various manifestations. This condition shows no true signs of uveitis, and glaucomatous optic neuropathy is less common than ocular hypertension. The term “chronic uveal traumatization syndrome” demonstrates the pathogenesis of this condition, namely prolonged intraocular lens trauma to the iris and/or ciliary body. It develops when the intraocular lens is located in the ciliary sulcus or naturally in the fibrous capsular bag and in case of combined fixation. Chronic uveal traumatization syndrome is most common after implantation of an intraocular lens with a sharp optical and haptic edge. The condition is characterized by periodic blurring or a sharp decrease in vision and floaters, depending on the severity and location of intraocular hemorrhage. Pain, photophobia, and eye redness are signs of secondary ocular hypertension. An early and pathognomonic sign is defects in the iris pigmented layer at the site of its contact with the intraocular lens, detected using transillumination. Intraocular hemorrhages appear as microhyphema, hyphema, and vitreous hemorrhage. Anterior chamber flare is caused by abnormalities in the blood–aqueous barrier, dispersion of pigment and blood cells. Relapses usually include corneal edema associated with ocular hypertension, toxic effects of degradating blood, and endothelial decompensation. Corneal edema is not typical for primary open-angle glaucoma, even in case of high intraocular pressure, but it does not rule out their combination. Chronic uveal traumatization syndrome is associated with pseudo-phacodonesis, capsular contraction syndrome, and intraocular lens dislocation. Rare manifestations include cystoid macular edema and glaucomatous optic neuropathy caused by secondary glaucoma. Unlike uveitis, chronic uveal traumatization syndrome is not characterized by no precipitates, hypopyon, or blurred iris pattern. Ultrasound biomicroscopy assesses the intraocular lens position (in the sulcus ciliaris, combined, or intracapsular), decentration, tilt, or deformation, capsular bag fibrosis, Soemmering ring, iris prolapse, optic or haptic contact with the iris and ciliary body. Timely diagnosis and pathogenesis-directed therapy prevent optic nerve atrophy associated with secondary glaucoma.