The authors consider published evidence with regard to potential causative mechanisms for secondary glaucoma that follows infant lensectomy. They review clinical and laboratory studies. The mechanism they propose is that the original lensectomy surgery releases immature anterior lens cells into the anterior chamber which, in turn, impact the trabecular meshwork. Secondary filtration angle defects then occur. Subsequent connective tissue proliferation ensues with development of secondary anterior chamber pathology. They propose than an understanding of the pathological mechanism may aid development of future medical treatments. In the short-term, a delay of surgery until after 12 weeks of age, and surgery with complete removal of anterior lens capsule and adjacent lens cells to minimise lens cells dispersion may be of benefit to minimise the risk of developing secondary glaucoma.