Misdiagnosis or missed diagnosis: Occult lens subluxation in eyes presenting with acute angle closure glaucoma

Anterior subluxation of the crystalline lens can precipitate acute secondary angle closure with a rapid rise in intraocular pressure mimicking an attack of acute primary angle closure glaucoma. A high index of suspicion and a meticulous examination are needed for correct diagnosis as the definitive treatment in lens subluxation-induced acute secondary angle closure is removal of the crystalline lens. We describe five cases of acute secondary angle closure where lens subluxation was missed on the first examination. All patients underwent cataract extraction during which the lens subluxation/zonulopathy was confirmed and a capsular tension ring was implanted in four of them.