Traumatic Cataract

History
Traumatic cataracts are defined as those occurring post or secondary to blunt or penetrating ocular trauma/injury/blows. Infrared energy (glass-blower’s cataract), electrical shock, and also ionizing radiation are various other rare causes of traumatic cataracts. Cataracts brought on by blunt trauma characteristically create stellate or rosette-shaped posterior axial opacities (as can be seen in the images below) that might be steady or progressive, meaning they may sustain or increase with the passing of time, whereas penetrating trauma with disruption of the lens capsule forms cortical changes that might remain focal if small or may proceed rapidly to overall cortical opacification (both of these may lead to traumatic cataracts). Researchers have found that traumatic cataracts without globe rupture normally have a better prognosis for visual healing after surgical treatment, at the hands of an experienced ophthalmologist, at the very least in children.

View images below:

Fig. 1: Classic rosette-shaped cataract in a male, 4 weeks after blunt eye injury.

Fig. 2: Same cataract as seen in previous image of male with 4-week-old eye injury, viewed by retro-illumination.

Lens dislocation and also subluxation are generally found together with traumatic cataract. Other associated problems include phacolytic, phacomorphic, pupillary block, and angle-recession glaucoma; phaco-anaphylactic uveitis; retinal detachment; choroidal rupture; hyphema; retrobulbar hemorrhage; stressful optic neuropathy; and also, globe rupture. Traumatic cataract can offer numerous medical as well as surgical difficulties to the ophthalmologist. Careful assessment and a management plan can simplify these tough cases and also provide the most effective possible end result.

Pathophysiology
Blunt trauma is responsible for coup and also contrecoup eye injury. Coup is the mechanism of straight impact. It is responsible for Vossius ring as it is called (which is also the imprinted iris pigment) often found on the anterior lens capsule following blunt trauma. Contrecoup describes distance injury caused by shockwaves following the line of blast. When the anterior surface of the eye is struck bluntly, there is a quick anterior-posterior shortening accompanied by equatorial expansion. This equatorial expansion or the sideways stretching can disrupt the lens capsule, zonules, or both at the same time. Combination of coup, contrecoup, as well as equatorial expansion or sideways stretching is responsible for development of traumatic cataract following blunt (but not penetrating) ocular injury. Penetrating trauma that directly compromises the lens capsule results in cortical opacification at the site of injury. If the rent is adequately large, the entire lens rapidly opacifies, but when small, cortical cataract can seal itself off and continue to be localized.

Epidemiology
Frequency
United States

Around 2.5 million eye injuries happen every year in the USA. It is approximated that roughly 4-5% of a comprehensive eye doctor’s patient are seen secondary to eye injury. Traumatic cataract may present as severe, subacute, or late sequela of eye injury.
Mortality/Morbidity
Injury is the leading source of monocular blindness in patients more youthful than 45 years. Yearly, around 0.05 million people are left incapable to read newsprint as an outcome of ocular injury. Only around 85% individuals that experience anterior segment injury reach a final visual acuity of 20/40 or far better, when perfect vision is 20/20 whereas only 40% patients with posterior segment injury reach this level, which is a much lower number.

Sex
The male-to-female proportion in instances of eye injury is 4:1.
Age
Job- and sports-related eye injuries most frequently happen in youngsters as well as young adults.

Prognosis
The prognosis is dependent on the degree or severity of the injury or trauma.

Patient Education

Protective eyewear is very important in risky activities to stay clear of injury.

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