Clinical photography: Epicapsular stars

Image supplied by Jong Lee, Specsavers Belmont Forum, WA

Presentation

Epicapsular stars (or congenital epicapsular pigmentation) are very small, stellate, pigment deposits on the anterior lens capsule. They can present unilaterally or bilaterally and may be present in clusters or in isolation.

They occur commonly in people of all ages and are best visualised under high magnification during slit lamp examination of the anterior segment. Most patients are completely asymptomatic as generally, epicapsular stars do not have any effect on vision.

Pathogenesis

Epicapsular stars are a congenital anomaly that result from incomplete involution of the ‘tunica vasculosa lentis’. The tunica vasculosa lentis is a vascular network of capillaries that surrounds the lens during development of the embryo and then slowly disappears due to apoptosis (programmed cell death) near the time of birth. Other ocular findings that represent remnants of the tunica vasculosa lentis are Mittendorf dots – small opacities or strands attached to the posterior lens capsule – and persistent pupillary membranes.

Progression & Prognosis

Epicapsular stars tend not to affect vision. As epicapsular stars are congenital, they do not exhibit any change over time. If they are confluent and located across the visual axis, they can impede vision during development and cause amblyopia, however this is a rare occurrence. In cases where they are clinically significant, they can be surgically removed if they are deemed to be affecting vision.

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