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An 82-year-old female patient was referred for surgical repair of a full-thickness retinal macular hole associated with profound vision loss in the right eye. She was otherwise healthy and had no history or family history of muscle weakness. Slit-lamp examination revealed needle-like polychromatic crystals within the deep cortex of the crystalline lens (Fig. 1A). With retroillumination, in which the angle of light is perpendicular to the cataract, only an outline of the crystals is seen (Fig. 1B). At other angles of incident light, these refractile lenticular inclusions demonstrated a variety of colours, including pink, green, blue, red, and gold, reminiscent of Christmas tree tinsel (Fig. 1C, D). Known as a “Christmas tree cataract,” this form of media opacity is most commonly related to age-related degeneration of crystallin proteins associated with elevated calcium levels in the lens, as in our patient. In a subset of patients, Christmas tree cataracts have an important systemic association: autosomal-dominant myotonic dystrophy. Although these cataracts are often not visually significant, they can progress and impair vision. In this case, vision loss was secondary to the macular hole, but the patient deferred vitreoretinal surgery.
R.C.R. was supported by NIH/NEI K12EY022299. This sponsor had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.