Case 42
Figure 1: White cataract left eye
A 34 year male was referred with blurred vision in his left eye.
Case history
A 34 year old engineer was referred by his optometrist with blurred vision in the left eye which had been rapidly worsening over 4 months. His visual acuity was recorded at Right 6/5 and Left counting fingers. The examination demonstrated a white cataract in the left eye (Figure1). The right lens was clear.
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Differential diagnosis
What are the causes of unilateral cataract in a young adult?
- Traumatic
- Inflammatory
- Fuch's heterochromic iritis
- Chronic uveitis
- Fuch's heterochromic iritis
- Retinal detachment
- Iatrogenic
- Steroid induced
- Surgery
- Steroid induced
- Idiopathic
Additional history, examination and investigations
Figure 2: B scan ultrasound was performed to exclude a retinal detachment
Close inspection revealed subtleiris heterochromia (Figure 3) and stellate keratic precipitates.
Figure 3: There is subtle left iris hypochromia
DIAGNOSIS
Fuch’s Heterochromic Cyclitis
Treatment
After informed consent the patient underwent routine cataract surgery in the left eye. He had a monofocal lens implant with refractive target for distance.
Day 1 visual acuity of 6/7.5-. Postoperatively he used a standard regime of chloramphenicol, dexamethasone (Maxidex) and ketorolac (Acular) post operatively. At one month postoperatively acuity was 6/6+. Despite loss of accommodative function in the left eye he was still able to manage near tasks without glasses due to his right eye which still had good accommodative function.
Discussion
Fuch’s heterochromic iridocyclitis (FHI) is an uncommon chronic unilateral uveitis. It is increasingly thought to be related to rubella infection. The hallmark signs are:
- Iris heterochromia and atrophy
- Keratic precipitates (usually stellate and pan corneal)
- Low-grade iridocyclitis
- Cataract in the absence of posterior synechiae
