Scheimpflug imaging in Christmas tree cataract.

A 74-year-old man, known case of glaucoma, presented for a routine eye check-up. His best-corrected visual acuity in the right eye was 6/9 and the left eye was 6/12. His intraocular pressures were 14 in the right eye and 16 in the left eye on travoprost 0.004%. On slit lamp examination, we noticed atypical lenticular opacities in the left eye. There was the presence of multiple iridescent needle-shaped crystals in anterior lens stroma [Fig. 1a]. The multicoloured crystals were reminiscent of a Christmas tree. Pentacam Scheimpflug imaging revealed hyper-reflective shadows in the cortical and nuclear lens matter [Fig. 1b]. Christmas tree cataract is a rare type of cataract with an unclear mechanism of formation.[12] Association with myotonic dystrophy is reported in the literature.[3] Our patient's neurological examination was normal, and he was advised follow-up since he was comfortable with his vision.

Figure 1

(a) Anterior segment photograph of the left eye showing the presence of multiple polychromatic needle-shaped crystals in the lens giving an appearance of a lit-up Christmas tree. (b) Scheimpflug image of the left eye showing multiple hyper-reflective shadows in the anterior lens stroma

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