Traumatic Cataract Clinical Presentation

Updated: Sep 20, 2018
  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

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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Complications

Lens dislocation and subluxation are commonly found in conjunction with traumatic cataract. [4]

Other associated complications include the following: phacolyticphacomorphic, pupillary block, and angle-recession glaucoma; phacoanaphylactic uveitis; retinal detachment; choroidal rupturehyphema; retrobulbar hemorrhage; traumatic optic neuropathy; and globe rupture. [5]

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