Infrared radiation (glassblowers cataract)

 

I.    Describe the approach to establishing the diagnosis

A.    Describe the etiology of this disease

1.    Intense exposure to infrared radiation and heat causes the superficial lens capsule to delaminate and peel off in scrolls

B.    Define the relevant aspects of epidemiology of the disease

1.    Exposure to high levels of infrared radiation and heat

a.    Glassblowers

b.    Blast furnace operators

C.    List the pertinent elements of the history

1.    Exposure to infrared radiation/intense heat

2.    Decline in vision

D.    Describe pertinent clinical features

1.    Lens opacities

2.    Lens capsule delamination

E.    Describe appropriate testing and evaluation for establishing the diagnosis

1.    Slit lamp biomicroscopic examination

2.    B-scan ultrasound in cases of white cataract (See Ultrasound - clinical principles)

 

II.    Define the risk factors

A.    History of exposure to physical forces

1.    Infrared radiation/heat

a.    Requires intense levels often for prolonged periods (years)

 

III.    List the differential diagnosis

A.    Exfoliation syndrome (See Pseudoexfoliation and cataract surgery)

B.    Other type of cataract/traumatic cataract (See Traumatic cataract)

 

IV.    Describe patient management in terms of treatment and follow-up

A.    Describe the natural history, outcome and prognosis

1.    Progression of lens opacities

2.    Decrease in vision from affected eye

B.    Describe medical therapy options

1.    No significant medical therapy exists

C.    Describe surgical therapy options

1.    Cataract extraction and intraocular lens (IOL) placement

2.    Possible trypan blue dye to confirm full thickness capsulorrhexis

 

V.    List the complications of treatment, their prevention and management

A.    Possible capsular weakness

B.    Can be more difficult to secure the IOL

 

VI.    Describe appropriate patient instructions

A.    Avoid exposure to intense infrared radiation and heat

B.    Use of protective eyewear during high risk activities

 

Additional Resources

1.    AAO, Basic and Clinical Science Course. Section 11: Lens and Cataract, 2013-2014.

2.    Ritch R. Exfoliation Syndrome. Curr Opin Ophthalmol 2001 Apr; 12(2):124-30.

3.    Cooke CA, Lum DJ, et al. Surgical approach, histopathology, and pathogenesis in cataract associated with true lens exfoliation. J Cataract Refract Surg 2007 Apr;33(4):735-8.

4.    Karp CL, Fazio JR, et al. True exfoliation of the lens capsule. Arch Ophthalmol 1999 Aug; 117(8):1070-80.