A 37-year-old man presented with concern for vision loss. He said he was in an altercation and was hit in his left eye three weeks earlier. He didn't think he had vision loss initially, but his vision had become worse over the past week. The patient had no pain, other trauma, fevers, chills, pain with eye movement, headache, or vomiting. He said this was the first time he was seen for this.
The patient was afebrile, with a heart rate of 74 bpm and a blood pressure of 118/89 mm Hg. His eye looked as shown in the photo.
What does the patient have, and what is the management of his condition?
Find the diagnosis and case discussion on the next page.
Diagnosis: Traumatic Cataract
This patient had a traumatic cataract, which can happen after a blunt or penetrating trauma with enough force to disrupt the lens fibers. Electric shock and ionizing radiation can also cause traumatic cataracts, although these cases are rare. (Duane's Clinical Ophthalmology. Philadelphia: Williams and Wilkins; 1997.) The most common presentation of a traumatic cataract is the rosette or stellate type. (EyeNet Magazine. August 2016; https://bit.ly/2TZq6Wd.)
Blunt trauma tends to cause these classic-shaped cataracts, which can be stable or progressive. Traumatic cataracts not associated with an open-globe injury have a better visual recovery after surgery than those with an open-globe injury. (Eur J Ophthalmol. 2018;28:406.)
A traumatic cataract is formed from a combination of direct impact and a stretching mechanism that disrupts the lens capsule or zonules. (American Academy of Ophthalmology. Basic and Clinical Course, Section 8, 1997.) It is important to look for other ophthalmologic injuries when a patient presents with a traumatic cataract. A common associated traumatic injury is a lens dislocation or subluxation. Other complications are pupillary bloc, angle-recession glaucoma, uveitis, retinal detachment, choroidal rupture, hyphemia, retrobulbar hemorrhage, and globe rupture. (J Cataract Refract Surg. 2005;31:511.) It is important to evaluate for other facial injuries as well.
The prognosis of a traumatic cataract is related to how extensive the injury is and the other injuries involved. Eighty-five percent of patients who have an anterior segment injury will get to a visual acuity of 20/40. (Master Techniques in Ophthalmic Surgery. Philadelphia: Lippincott Williams and Wilkins; 1995.)
Traumatic cataracts are managed with surgery. This patient had only a traumatic cataract, and he was scheduled for outpatient surgery.
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Dr. Kaplanis an assistant professor of emergency medicine at the University of Colorado School of Medicine in Aurora. Read her past columns athttp://bit.ly/EMN-QuickConsult.