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Traumatic Cataract Clinical Presentation

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jun 15, 2016
 

History

Note the following:

  • Mechanism of injury - Sharp versus blunt
  • Past ocular history - Previous eye surgery, glaucoma, retinal detachment, diabetic eye disease
  • Past medical history - Diabetes, sickle cell, Marfan syndrome, homocystinuria, hyperlysinemia, sulfate oxidase deficiency
  • Visual complaints - Decreased vision (cataract, lens subluxation, lens dislocation, ruptured globe, traumatic optic neuropathy, vitreous hemorrhage, retinal detachment); monocular diplopia (lens subluxation with partial phakic and aphakic vision); binocular diplopia (traumatic nerve palsy, orbital fracture); pain (glaucoma secondary to hyphema, pupillary block, or lens particles; retrobulbar hemorrhage; iritis)
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Physical

Complete ophthalmic examination (defer in case of globe compromise), to include the following:

  • Vision and pupils - Presence of afferent pupillary defect (APD) indicative of traumatic optic neuropathy
  • Extraocular motility - Orbital fractures or traumatic nerve palsy
  • Intraocular pressure - Secondary glaucoma, retrobulbar hemorrhage
  • Anterior chamber - Hyphema, iritis, shallow chamber, iridodonesis, angle recession
  • Lens - Subluxation, dislocation, capsular integrity (anterior and posterior), cataract (extent and type), swelling, phacodonesis
  • Vitreous - Presence or absence of hemorrhage, posterior vitreous detachment
  • Fundus - Retinal detachment, choroidal rupture, commotio retinae, preretinal hemorrhage, intraretinal hemorrhage, subretinal hemorrhage, optic nerve pallor, optic nerve avulsion
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Causes

Traumatic cataracts occur secondary to blunt or penetrating ocular trauma.

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Contributor Information and Disclosures
Author

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Coauthor(s)

Brian C Mulrooney, MD Private Practice, Ophthalmology, Crestwood Hospital

Brian C Mulrooney, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

References
  1. Tasman W, Jaeger EA. Traumatic cataract. Duane's Clinical Ophthalmology. 1997. 1: 13-4.

  2. Dinakaran S, Kayarkar VV. Traumatic retinal break from a viscoelastic cannula during cataract surgery. Arch Ophthalmol. 2004 Jun. 122(6):936. [Medline].

  3. Jaffe NS, Jaffe MS, Jaffe GF. Lens displacement. Cataract Surgery and Its Complications. 1997. 200-11.

  4. Sarikkola AU, Sen HN, Uusitalo RJ, Laatikainen L. Traumatic cataract and other adverse events with the implantable contact lens. J Cataract Refract Surg. 2005 Mar. 31(3):511-24. [Medline].

  5. Kanski JJ. Clinical Ophthalmology: A Systematic Approach. 1989. 257-8.

  6. Shah MA, Shah SM, Shah SB, Patel CG, Patel UA. Morphology of traumatic cataract: does it play a role in final visual outcome?. BMJ Open. 2011 Jan 1. 1(1):e000060. [Medline]. [Full Text].

  7. Schwab IR, et al. Anterior segment trauma. AAO Basic and Clinical Science Course. Section 8. 1997. 285-6.

  8. Witherspoon CD, Kunh F, Morris R, et al. Anterior and posterior segment trauma. Master Techniques in Ophthalmic Surgery. 1995. 538-47.

  9. Tabatabaei A, Kiarudi MY, Ghassemi F, Moghimi S, Mansouri M, Mirshahi A, et al. Evaluation of posterior lens capsule by 20-MHz ultrasound probe in traumatic cataract. Am J Ophthalmol. 2012 Jan. 153(1):51-4. [Medline].

  10. Kumar A, Kumar V, Dapling RB. Traumatic cataract and intralenticular foreign body. Clin Experiment Ophthalmol. 2005 Dec. 33(6):660-1. [Medline].

  11. Rofagha S, Day S, Winn BJ, Ou JI, Bhisitkul RB, Chiu CS. Spontaneous resolution of a traumatic cataract caused by an intralenticular foreign body. J Cataract Refract Surg. 2008 Jun. 34(6):1033-5. [Medline].

  12. Tabatabaei A, Hasanlou N, Kheirkhah A, Mansouri M, Faghihi H, Jafari H, et al. Accuracy of 3 imaging modalities for evaluation of the posterior lens capsule in traumatic cataract. J Cataract Refract Surg. 2014 Jul. 40 (7):1092-6. [Medline].

  13. Shah MA, Shah SM, Patel KD, Shah AH, Pandya JS. Maximizing the visual outcome in traumatic cataract cases: The value of a primary posterior capsulotomy and anterior vitrectomy. Indian J Ophthalmol. 2014 Nov. 62 (11):1077-1081. [Medline].

  14. Trivedi RH, Wilson ME. Posterior capsule opacification in pediatric eyes with and without traumatic cataract. J Cataract Refract Surg. 2015 Jul. 41 (7):1461-4. [Medline].

  15. Chuang LH, Lai CC. Secondary intraocular lens implantation of traumatic cataract in open-globe injury. Can J Ophthalmol. 2005 Aug. 40(4):454-9. [Medline].

  16. Phillips PM, Shamie N, Chen ES, Terry MA. Transscleral sulcus fixation of a small-diameter iris-diaphragm intraocular lens in combined penetrating keratoplasty and cataract extraction for correction of traumatic cataract, aniridia, and corneal scarring. J Cataract Refract Surg. 2008 Dec. 34(12):2170-3. [Medline].

  17. Kumar S, Panda A, Badhu BP, Das H. Safety of primary intraocular lens insertion in unilateral childhood traumatic cataract. JNMA J Nepal Med Assoc. 2008 Oct-Dec. 47(172):179-85. [Medline].

  18. Shingleton BJ, Hersh PS, Kenyon KR, et al. Lens injuries. Eye Trauma. 1991. 126-34.

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Classic rosette-shaped cataract in a 36-year-old man, 4 weeks after blunt ocular injury.
Same cataract as seen in previous image, viewed by retroillumination.
 
 
 
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