A unilateral spherophakic crystalline lens that randomly and uninhibitedly moves across the anterior and posterior chambers in a pediatric patient is a rare entity.
I came across a 5-year-old girl who had this clinical condition in her left eye. A detailed ocular examination revealed no other significant clinical finding. The anterior chamber and retina were normal, and there was no other associated systemic abnormality.
The position of the crystalline lens would change with the head posture. The lens would prolapse into the anterior chamber in the head-down position and fall into the vitreous cavity in the supine position. Attempts to constrict the pupil with the instillation of pilocarpine eye drops while the lens was in the anterior chamber were futile because the pupil failed to constrict and remained in a semi-dilated condition. With complete dislocation of the lens into the anterior chamber, a characteristic “oil drop” appearance was seen.
A three-port pars plana vitrectomy was done, along with lensectomy and fixation of the IOL by glued intrascleral fixation.