eMedicine Specialties > Ophthalmology > Lens

Cataract, Traumatic: Treatment & Medication

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

Treatment

Medical Care

  • If glaucoma is a problem, control intraocular pressure with standard medications. Add corticosteroids if lens particles are the cause or if iritis is present.
  • Focal cataract
    • Observation is warranted if the cataract is outside the visual axis.
    • Miotic therapy may be of benefit if the cataract is close to the visual axis.
  • In some cases of lens subluxation, miotics may correct monocular diplopia. Mydriatics may allow for vision around the lens with aphakic correction.

Surgical Care

  • Planning the surgical approach is of the utmost importance in cases of traumatic cataract.
  • Preoperative capsular integrity and zonular stability should be surmised.
  • In cases of posterior dislocation without glaucoma, inflammation, or visual obstruction, surgery may be avoided.
  • Indications for surgery include the following:
    • Unacceptable decreased vision
    • Obstructed view of posterior pathology
    • Lens-induced inflammation or glaucoma
    • Capsular rupture with lens swelling
    • Other trauma-induced ocular pathology necessitating surgery
  • Standard phacoemulsification may be performed if the lens capsule is intact and sufficient zonular support remains.
  • Intracapsular cataract extraction is required in cases of anterior dislocation or extreme zonular instability. Anterior dislocation of the lens into the anterior chamber requires emergency surgery for its removal, as it can cause pupillary block glaucoma.
  • Pars plana lensectomy and vitrectomy may be best in cases of posterior capsular rupture, posterior dislocation, or extreme zonular instability.
  • Automated irrigation/aspiration can be used in patients younger than 35 years.
  • Lens implantation
    • Capsular fixation is the preferred placement if the lens capsule and zonular support are intact.
    • Polymethyl methacrylate (PMMA) capsular tension rings allow capsular fixation in cases of zonular dialysis less than 180 degrees.
    • Sulcus fixation is safe if the posterior capsule is compromised but zonular support is maintained.
    • Suture fixation is chosen if both capsular and zonular supports are insufficient and the angle is minimally damaged.
    • Anterior chamber placement is an option if no posterior support remains and iris or ciliary body trauma prevents suture fixation.
    • Aphakia may be a better choice in young children and in patients with highly inflamed eyes, as they may experience better outcomes if lens implantation is deferred.

Consultations

Vitreoretinal consultation is necessary if a pars plana approach is mandated and the surgeon is untrained in posterior segment surgery.

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

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

  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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