Eyelids & the Anterior Segment:
                      Case twenty nine

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This 65 year-old man was referred by his optician because of the above appearance. He was aphakic and had had laser treatment for proliferative diabetic retinopathy in the past.

a. What does the picture show?

Synchisis scintillans (cholesterolosis) in the anterior chamber.
Refractive yellowish crystals can be seen at the bottom of the anterior chamber and some floating freely in the anterior chamber.

b. What is the significane of this condition?

Synchisis scintillans is made up of cholesterol crystals and usually results from incompletely resolved intraocular haemorrhage. It is seen in eyes with previous ocular trauma, inflammation or vitreous haemorrhage of various causes.

The cystals float freely and settle inferiorly in the absence of movement. In aphakic eyes, the crystals can spill into the anterior chamber. In hot weather, the crystals in the anterior chamber may dissolve as the cholesterol have low melting point only to reform when the temperature decreases.