ACTA OPHTHALMOLOGICA VOL. 4 3 1965

From the Ophthalmic Clinic of the University of Lund,'Sweden (Head: Prof . Erik Palm, M . D.)

ANOREXIA NERVOSA ASSOCIATED WITH CATARACT:>) (Report of a case.)

BY

Goran Stigmar

INTRODUCTION

There a r e several causes of juvenile cataracts. They may be due to endocrine and metabolic disorders, deficiency syndromes or they may be associated with diseases of the skin o r muscular system. Sometimes there is n o associated pathology. This case report first seemed to illustrate the la t ter situation until it turned out to be a probable consequence of a 4-year-history of anorexia nervosa.

CASE REPORT

The patient was a 30-year-old dental mechanic. In 1958 she married but because of her husband's abuse of alcohol there was a divorcement in 1962. There is no family history of cataract. Physically the patient developed normally during childhood and adolescence. Prior to that time she allegedly had had no difficulty with her vision. Shortly after her marriage her menses became irregular, scanty, and farther apart until amenorrhea began one year later. At this time she began to lose weight gradually and in the next 3 years she lost 28 kg. During this period her vision began to fail. When examined in 1959 she had a corrected visual acuity of 0,7 0. D. and 0,5 0. S. The eyes were pale, there was no signs of intraocular inflammation. Slit lamp exa- mination revealed bilateral posterior subcapsular lens opacities bilaterally. The fundi were normal. The opacities increased with progressive visual loss and she was admitted to an ophthalmological department, 1960. At that time visual acuity was 0,2 bilaterally. Slit-lamp examination now revealed a dense irregular posterior cataract. A capsular discision followed by evacuation was performed on the left eye. The final visual acuity of 1,0 with a + 11 sphere. In 1962 a capsular discision was performed on the

*) Received May 12th 1965.

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right eyc It was repeated 4 months later with a good result, however. A retinal detachment developed in the right eye and she was admitted to the University Eye Clinic in Lund.

On examination she was found to be a thin but otherwise healthy individual. Height 163 cm. Weight 44,5 kg. The skin showed a mild brown pigmentation. The sub- cutaneous fat was reduced especially on her legs. There were no signs of latent tetany (Chvosteb’s sign negative). Studies of blood sodium, inorganic phosphate and calcium were norinal as well as her renal function, but blood potassium was decreased (2,5 mekv. Ntirmally 3,745). During the following days, however, the blood potassium gradually was normalized. This aroused suspicion of a gastro-intestinal disorders and after some days the patient herself solved the mystery by revealing that during the preceding 4-5 years she had had self-induced vomitis. In addition she had drug- induced tliarrhoae from eating frangulae pills. The retinal detachment was operated on successfully. Later a complete endocrinological analysis and an examination by a psyciatrisl verified the diagnosis of anorexia nervosa.

DISCUSSION

Anorexici nervosa occurs most commonly in the adolescent female and leads to malnutrition due to deficient diet, in which the caloric restriction is entirely psychological and not due to any gross disease. The triad of failure to eat, weight loss and menstrual changes is typical. The severe malnutrition of anorexia nervosa may produce a clinical picture resembling that seen in cases of panhypopituitarism with failure of the endocrine function of the gonads, thyroid md the adrenal cortex (1). A modest anemia is usually noted but clinical signs of vitamin deficiencies are rare. Self-induced emesis and addic- tion to the use of laxatives and enemas may accompany anorexia nervosa and result in changes in the electrolytes as in this case with a decrease of blood potassium. There are no reports in the literature of cataract associated with anorexia nervosa. No similar case could be found in more than 60 cases of anorexia nervosa collected at the department of psychiatry of the University of Lund (only three of these patients, however, had been examinated by an ophthalmologist) (4).

There are, however, many reports of changes of the crystalline lens from studies in other forms of human starvation as well as in animals. Cataracta cachectica is a concept introduced to embrace the lenticular changes which occasionally are seen in toxic states as in cachexia after prolonged starvation, in severe anemia or in infectious diseases such as small-pox and scarlet- fever (2) Cataract due to a persistent diarrhoea is also reported (3).

The cause of the cataract in the presented case is obscure. It may be due to changes in the blood potassium or in the other electrolytes and fluid balance, osmotic disturbances, or is the effect of a nutritional deficiency.

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SUMMARY

A case of anorexia nervosa associated with cataract is presented. I t belongs to the group of cataracts known as cataracta cachectica. In t&s particular case a low blood potassium level was noted, but it permits no conclusions of the etiology of the cataract.

REFERENCES

1. Bliss, E. L. and Branch, C. H . H.: Anorexia nervosa, its history, psychology, and

2. Duke-Elder, S.: Textbook of Ophthalmology. Kimpton, London 1940, vol. 111,

3. Bungerter, A.: Katarakt bei einheimischer Sprue. Ophthalmologica 1939, 98, p. 3224. 4. Theunder, S.: Personal communication.

biology. Paul B. Hoeber Inc.

p. 3224.

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