Phacomorphic glaucoma is type of angle closure glaucoma in which it occurs as a complication of mature large sized cataract. It occurs more common in old age people who have less access to eye care, so this condition will be ignored and also it can occur after trauma in which the cataract can become large with time.
With age, the size of cataract will increase in size in both the anterio-posterior level and equatorial level. The lens lies behind the iris and there is a space between the iris and the lens in which the aqueous will follow naturally from the posterior chamber to the anterior chamber through this space. As the size of the cataract increase, this space will gradually get smaller and aqueous outflow resistance will occur, leading to increase in intraocular pressure. Sometimes, this cataract will push on the iris leading to complete close of this space with sudden increase in intraocular pressure. This type of angle closure glaucoma is called pupillary block and it is an acute condition and can cause sever damage to the ocular structures if not treated as soon as possible.
The patient with phacomorphic glaucoma will come will see eye pain and headache with nausea and vomiting and on ocular examination there will be corneal edema due to high intraocular pressure which can reach 50 MmHg or even more. Also the anterior chamber will be due because the iris is pushed anteriorly by the large cataract. Also be examination, there will be large mature cataract and we can see touch between the cataract and the iris.
Treatment of this condition should be done by cataract surgery extraction but before this surgery, your eye doctor should decrease the intraocular pressure by antiglaucoma medicines which can be either eye drops, oral medications or sometimes with laser iridectomy which is a hole created by laser on the iris to allow the aqueous humor to flow from the posterior chamber to anterior chamber. Once the intraocular pressure is reduced, a cataract surgery should be done to extract the cataract and replace it with artificial intraocular lens.