eMedicine Specialties > Ophthalmology > Lens

Cataract, Traumatic

Author: Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Coauthor(s): Brian C Mulrooney, MD, Private Practice, Ophthalmology, Crestwood Hospital
Contributor Information and Disclosures

Updated: Feb 4, 2009

Introduction

Background

Traumatic cataracts occur secondary to blunt or penetrating ocular trauma. Infrared energy (glass-blower's cataract), electric shock, and ionizing radiation are other rare causes of traumatic cataracts.

Cataracts caused by blunt trauma classically form stellate- or rosette-shaped posterior axial opacities that may be stable or progressive, whereas penetrating trauma with disruption of the lens capsule forms cortical changes that may remain focal if small or may progress rapidly to total cortical opacification.

Lens dislocation and subluxation are commonly found in conjunction with traumatic cataract. Other associated complications include phacolytic, phacomorphic, pupillary block, and angle-recession glaucoma; phacoanaphylactic uveitis; retinal detachment; choroidal rupture; hyphema; retrobulbar hemorrhage; traumatic optic neuropathy; and globe rupture.

Traumatic cataract can present many medical and surgical challenges to the ophthalmologist. Careful examination and a management plan can simplify these difficult cases and provide the best possible outcome.

Pathophysiology

Blunt trauma is responsible for coup and contrecoup ocular injury. Coup is the mechanism of direct impact. It is responsible for Vossius ring (imprinted iris pigment) sometimes found on the anterior lens capsule following blunt injury. Contrecoup refers to distant injury caused by shockwaves traveling along the line of concussion.

When the anterior surface of the eye is struck bluntly, there is a rapid anterior-posterior shortening accompanied by equatorial expansion. This equatorial stretching can disrupt the lens capsule, zonules, or both. Combination of coup, contrecoup, and equatorial expansion is responsible for formation of traumatic cataract following blunt ocular injury.

Penetrating trauma that directly compromises the lens capsule leads to cortical opacification at the site of injury. If the rent is sufficiently large, the entire lens rapidly opacifies, but when small, cortical cataract can seal itself off and remain localized.

Frequency

United States

Approximately 2.5 million eye injuries occur annually in the United States. It is estimated that approximately 4-5% of a comprehensive ophthalmologist's patients are seen secondary to ocular injury. Traumatic cataract may present as acute, subacute, or late sequela of ocular trauma.

Mortality/Morbidity

  • Trauma is the leading cause of monocular blindness in people younger than 45 years.
  • Annually, approximately 50,000 people are left unable to read newsprint as a result of ocular trauma.
  • Only 85% patients who experience anterior segment injury reach a final visual acuity of 20/40 or better, whereas only 40% patients with posterior segment injury reach this level.

Sex

The male-to-female ratio in cases of ocular trauma is 4:1.

Age

  • Work- and sports-related eye injuries most commonly occur in children and young adults.
  • Between 1985-1991, a National Eye Trauma System study reported a median age of 28 years in 648 assault-related cases.

Clinical

History

  • 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

Physical

  • Complete ophthalmic examination (defer in case of globe compromise)
    • 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

Causes

Traumatic cataracts occur secondary to blunt or penetrating ocular trauma.

More on Cataract, Traumatic

Overview: Cataract, Traumatic
Differential Diagnoses & Workup: Cataract, Traumatic
Treatment & Medication: Cataract, Traumatic
Follow-up: Cataract, Traumatic
Multimedia: Cataract, Traumatic
References
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References

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

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

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

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

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

  7. 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. Dec 2008;34(12):2170-3. [Medline].

  8. 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. Jun 2008;34(6):1033-5. [Medline].

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

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

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

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

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

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Further Reading

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Keywords

traumatic cataract, traumatic cataracts, ocular trauma, blunt trauma, vision loss, visual deficit

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Contributor Information and Disclosures

Author

Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society
Disclosure: WebMD/eMedicine Salary 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.

Medical Editor

Richard W Allinson, MD, Associate Professor, Department of Surgery, 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, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
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, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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