Moran CORE

Open source ophthalmology education for students, residents, fellows, healthcare workers, and clinicians. Produced by the Moran Eye Center in partnership with the Eccles Library

Search Moran CORE

Lens Histopathology

Home / Ophthalmic Pathology / Lens

Normal Lens

Mamalis Lens 01 unlabeled  Mamalis Lens 01 labeled

10.01 Normal Lens

Mamalis Lens 02 unlabeled  Mamalis Lens 02 labeled

10.02 Magnified lens (PAS stain)

Mamalis Lens 03 unlabeled  Mamalis Lens 03 labeled

10.03 Equatorial lens

Mamalis Lens 04  Mamalis Lens 04 labeled

10.04 Normal cortical Lens fibers

Nick’s Tips: The normal lens can be identified by its shape and position in the eye and by the absence of definable cellular features such as nuclei (except in the cell of the anterior capsule and the lens bow). Additionally, the long fibrous cell lacking nuclei that run parallel to the adjacent capsule unambiguously identify lens under the microscope. Phakia in pseudophakia or phacoemulsification comes from the Greek, “Phakos” meaning lentil (a small bean roughly the shape of the lens).

Normal Lens

Lens Capsule:


Nucleus and Cortex


Mamalis Lens 05 unlabeled  Mamalis Lens 05 labeled

10.05 Zonules


Ectopia Lentis:

Nick’s Tips: important to remember the causes of spontaneous lens subluxation and the common direction in which the lens dislocates in each syndrome.

Mamalis Lens 06 unlabeled  Mamalis Lens 06 labeled

10.06 External slit lamp photo

Mamalis Lens 07 unlabeled  Mamalis Lens 07 labeled

10.07 External Slit Lamp photo

Mamalis Lens 08 unlabeled  Mamalis Lens 08 labeled

10.08 Weill-Marchesani

Mamalis Lens 09 unlabeled  Mamalis Lens 09 labeled

10.09 External Slit lamp photo

Congenital Aphakia:



Lens Coloboma

Nick’s Tips: Rarely associated with pediatric ciliary body neoplasm –most common is medulloepithelioma

Lentiglobus (lenticonus)



Phacoantigenic Uveitis:

Mamalis Lens 10 unlabeled  Mamalis Lens 10 labeled

10.10 External slit lamp photo

Nick’s Tips: The history of trauma or surgery and the presence of lens material and giant cells confirms the diagnosis.

Phacolytic Galucoma:

Mamalis Lens 11 unlabeled  Mamalis Lens 11 labeled

10.11 External slit lamp photo

Mamalis Lens 12 unlabeled  Mamalis Lens 12 labeled


P. acnes Endopthalmitis

Nick’s Tips: Clinical history of cataract surgery and chronic granulomatous inflammation, gram + cocci bacteria associated with lens capsule.

Persistent Fetal Vasculature (Previously called persistent hyperplastic primary vitreous (PHPV))

Mamalis Lens 13 unlabeled  Mamalis Lens 13 labeled

10.13 External slit lamp photo

Mamalis Lens 14 unlabeled  Mamalis Lens 14 labeled

10.14 Gross cross-section globe

Mamalis Lens 15 unlabeled  Mamalis Lens 15 labeled

10.15 PHPV

Nick’s Tips: Understanding the embryology of the lens is helpful in understanding the basics of the persistent fetal vasculature syndrome, which is a spectrum of remaining structure that can be very mild or severe and vision threatening. Also an important cause of leukocoria, the causes of which should be memorized and understood due to their association with life and vision threatening conditions.


Chalcosis / Wilson’s Disease


Nick’s Tips: look for history of high IOP and degenerating epithelium and cortical fibers.


Nick’s tips: Look for history of metallic foreign body and Prussian blue stain


Nuclear Cataract:

Mamalis Lens 16 unlabeled  Mamalis Lens 16 labeled

10.16 Posterior view of nuclear sclerotic cataract using Miyake view

Mamalis Lens 17 unlabeled  Mamalis Lens 17 labeled

10.17 Brunescent cataract

Mamalis Lens 19 unlabeled  Mamalis Lens 19 labeled

10.18 Dense nuclear cataract

Mamalis Lens 18 unlabeled  Mamalis Lens 18 labeled

10.19 Nuclear cataract

Nick’s Tips: nuclear cataract usually looks like homogenous eosinophilic sheet. Gaps are artifacts of processing, but as the lens hardens, there are fewer gaps and greater eosinophilia with increasing density of cataract.

Cortical cataract

Mamalis Lens 20 unlabeled  Mamalis Lens 20 labeled

10.20 External slit lamp photo

Mamalis Lens 21 unlabeled  Mamalis Lens 21 labeled

10.21 Cortical cataract from Miyake view

Mamalis Lens 22 unlabeled  Mamalis Lens 22 labeled

10.22 Morgagnian cataract

Mamalis Lens 23 unlabeled  Mamalis Lens 23 labeled

10.23 Gross morgagnian cataract

Mamalis Lens 24 unlabeled  Mamalis Lens 24 labeled

10.24 Early liquefied cortical cataract

Mamalis Lens 25 unlabeled  Mamalis Lens 25 labeled

10.25 Advanced cortical cataract

Anterior subcapsular cataract:

Mamalis Lens 26 unlabeled  Mamalis Lens 26 labeled


Mamalis Lens 27 unlabeled  Mamalis Lens 27 labeled

10.27 Trichrome Stain

Posterior subcapsular cataract:

Mamalis Lens 28 unlabeled  Mamalis Lens 28 labeled

10.28 Slit lamp photo retro-illumination

Mamalis Lens 29 unlabeled  Mamalis Lens 29 labeled

10.29 Swollen bladder cells

Nick’s Tips: Wedl cells present –lens cells swollen with lens protein containing a single nucleus -normally no nuclei in posterior lens.

Congenital Rubella Cataract:

Mamalis Lens 30 unlabeled  Mamalis Lens 30 labeled

10.30 External slit lamp photo

Mamalis Lens 31 unlabeled  Mamalis Lens 31 labeled

10.31 Gross cross-section of orbit

Mamalis Lens 32 unlabeled  Mamalis Lens 32 labeled

10.32 Congenital rubella

Nick’s Tips: Congenital Cataract can be inherited or acquired, but present at birth. Congenital cataract is an important cause of leukocoria in a child. The causes of leukocoria should be memorized both due to their importance in pediatric ophthalmology in recognizing and differentiating life and vision threatening conditions and because the Ophthalmology written and oral boards will frequently if not always address pediatric leukocora.

Cataracts in Systemic and Environmental Conditions:

Mamalis Lens 33 unlabeled  Mamalis Lens 33 labeled

10.33 True exfoliation

Mamalis Lens 34 unlabeled  Mamalis Lens 34 labeled

10.34 True exfoliation


Mamalis Lens 35 unlabeled  Mamalis Lens 35 labeled

10.35 External slit lamp photo retro-illumination

Mamalis Lens 36 unlabeled  Mamalis Lens 36 labeled

10.36 External slit lamp photo

Mamalis Lens 37 unlabeled  Mamalis Lens 37 labeled

10.37 External slit lamp photo

Mamalis Lens 38 unlabeled  Mamalis Lens 38 labeled

10.38 Pseudoexfoliation

Soemmering Ring/ Elschnig Pearls:

Mamalis Lens 39 unlabeled  Mamalis Lens 39 labeled

10.39 Cross-section of gross globe

Mamalis Lens 40 unlabeled  Mamalis Lens 40 labeled

10.40 Miyake view

Mamalis Lens 41 unlabeled  Mamalis Lens 41 labeled

10.41 Miyake View

Mamalis Lens 42 unlabeled  Mamalis Lens 42 labeled

10.42 Soemmering’s ring

IOL Complications:

Mamalis Lens 43 unlabeled  Mamalis Lens 43 labeled

10.43 UGH syndrome

Mamalis Lens 44 unlabeled  Mamalis Lens 44 labeled

10.44 IOL glistenings

Nick’s Tips: To avoid complications, good surgical technique is essential.

Self-Test Questions:

  1. Lens fibers originate from which of the following structures?
    a) The posterior capsule
    b) The anterior capsule
    c) The ciliary body
    d) The lens bow
  2. A patient presents with oil droplet appearance to the lens on retroillumination and deafness. You should consider which of the following tests?
    a) MRI brain and orbits
    b) Urinalysis
    c) RNFL OCT
    d)Complete blood count
  3. A 34 yo male presents to your clinic with rednessand pain OD with a history of trauma from a metallic foreign body 6 months ago. The patient eventually develops a blind and painful eye which is removed. The following histopatholgy is shown. What was the etiology of the patient’s disorder?
    a) Phacoantigenic Uveitis
    b) Siderosis
    c) P. acnesendophthalmitis
    d) Chalcosis
  4. A patient presents with the following cataract. What predisposing factor is most likely in this presentation?
    a) History of penetrating ocular trauma
    b) Wilson’s Disease
    c) Diabetes
    d) Hemochromatosis
  5. A patient presents with chronic pain, redness, and elevated intraocular pressure over the course of 6 months following cataract surgery. The patient has the following anterior segment exam. What is the most likely type lens placed.
    a) 3-piece silicone
    b) 1-piece acrylic multifocal
    c) Plate haptic PMMA
    d) 3-piece acylic

Answers: 1) D, 2) B, 3) A, 4) C, 5) B