Tear drop sign in posterior polar cataract: A clue to hidden capsular dehiscence

A 50-year-old patient presented with diminution of vision in both eyes. On clinical examination, bilateral posterior polar cataracts (PPCs) were observed. Notably, the right eye exhibited a pre-existing posterior capsular defect, as demonstrated in Fig. 1. Anterior segment optical coherence tomography (AS-OCT) confirmed the presence of a posterior capsular defect Fig. 1c, while Pentacam imaging revealed the characteristic “tear drop sign” Fig. 1d.Figure 1: (a) Slit lamp diffuse illumination showing characteristic onion peel or bull’s eye appearance. (b) Slit lamp retro illumination shows defect in posterior capsule. (c) Anterior segment optical coherence tomography showing defect in posterior capsule. (d) Pantacam shows characteristic “tear drop sign”Posterior polar cataract is an autosomal dominant inherited form of cataract.1 It is associated with abnormal adhesion between the lens opacity and the posterior capsule, or with a congenital weakness or dehiscence of the posterior capsule. These features significantly increase the risk of posterior capsule rupture (PCR) during cataract surgery.2 Preoperative identification of such anomalies is critical as it allows for strategic surgical planning and helps in minimizing intraoperative complications. Detailed imaging studies like AS-OCT and Pentacam play a pivotal role in assessing capsular integrity and guiding appropriate surgical techniques.2–4 Authors contributions Dr. Pradeep Tekade - concept, design, definition of intellectual content, literature search, manuscript preparation, manuscript editing and manuscript review. Dr Nikhilesh wairagade- manuscript editing and manuscript review. Dr Madhavi Agrawal- manuscript preparation, Data acquisition. Dr Ravi Daberao- - manuscript editing and manuscript review. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.