What is Traumatic Cataract (Eye Injury – Cataract)?
Ocular trauma, or eye injuries, are a major reason why people lose their vision. Each year, around 1.6 million people become blind due to cataracts caused by such injuries. Roughly 20% of all adults have experienced an eye injury, with men and young individuals being affected the most. Globally, an estimated 55 million eye injuries happen each year, and developed countries often see a high rate of blindness in one eye.
It’s extremely important to properly evaluate and treat eye injuries, and there are guidelines available to predict what the patient’s vision will be like after recovery. Elements like the initial clarity of vision, the response of the pupil to light, and how severe the injury is, all play a part in that evaluation.
This piece provides a complete guide to handling injuries to the lens, especially cataracts caused by trauma. It covers sterile procedures before surgery, when to perform the surgery, and how to make that decision. With this approach, patients can get the right treatment and care which leads to better vision after an eye injury.
What Causes Traumatic Cataract (Eye Injury – Cataract)?
Eye injuries can happen in many ways and they can damage the lens of the eye, which is needed for clear vision. This damage can come from things like a sharp or blunt impact to the eye, an electric shock, exposure to harmful radiation, or from chemical injuries.
If an eye is pierced by a sharp object like glass, wood, or metal, it can result in a traumatic cataract, which means the lens becomes cloudy and affects the vision. This can happen immediately after the eye is pierced, if the object reaches the lens after going through the cornea, the clear front part of the eye. The lens could also be partly or fully ruptured, leading to partial or full cataracts and even blindness.
Chemicals can harm the eye, too, by changing the makeup of the lens fibers, leading to traumatic cataracts. Exposure to radiation can likewise damage and rupture the lens, causing traumatic cataracts over time. This kind of damage from radiation is often seen in children.
Clouding of the lens can happen straight after an injury or appear years later; the type of cataract that forms depends on the nature and extent of the eye injury. Cataracts caused by a piercing injury often match the size of the hole in the lens capsule, but there is no common pattern to how these cataracts look.
In contrast, cataracts due to blunt trauma to the eye often have a unique rosette or flower-like appearance. Bigger holes in the lens can make the whole lens cloudy, while smaller holes might only cause a small area of cloudiness. Blunt trauma can also cause cataracts without the lens capsule being damaged, because of the force at the time of injury or inflammation afterwards. Eye injuries can also lead to clouding beneath the capsule of the lens.
Electric shocks to the eye can cause a milky-white clouding or multiple snowflake-like spots. Ultraviolet radiation can cause the outer lens to peel off, followed by a cataract developing. Ionizing radiation, used to treat eye tumors or during heart procedures, can cause cloudings in the back of the lens capsule.
Finally, chemical damage to the lens can come from various sources, such as naphthalene, thallium, lactose, and galactose.
Risk Factors and Frequency for Traumatic Cataract (Eye Injury – Cataract)
Out of all the people who experience an eye injury, about 65% develop cataracts as a result. These traumatic cataracts can seriously impair vision both shortly after the injury and in the long term. Eye injuries are fairly common, occurring in about one out of every five adults. Men and young people are more likely to experience these injuries. Globally, there are about 55 million eye injuries each year, and up to 1.6 million people lose their vision due to a cataract caused by an eye injury.
The likelihood of developing a cataract after an eye injury can be influenced by a number of factors including age, sex, where a person lives, and their socioeconomic status. Men, for instance, are more likely to experience eye injuries because they are often participating in outdoor activities. However, their chances of recovering their vision are about the same as women’s. Younger people are also more likely to get an eye injury, but they respond well to treatment. People living in rural areas are more likely to have an eye injury, but they are as likely to regain their vision as people living in cities. Finally, the specific cause of the eye injury can vary depending on where someone lives and their socioeconomic status, but these factors do not significantly affect the person’s chances of recovery.
Signs and Symptoms of Traumatic Cataract (Eye Injury – Cataract)
If you experience an eye injury, the first thing the medical team will do is to check if it’s an emergency and whether the injury came from a blunt force or something puncturing the eye. If the pressure in your eye is very low, it could mean the eye is open (meaning the outer layer has been breached), which has implications on the type of medications that can be used to treat the injury. This is especially important in children who might not be able to explain how the injury happened, meaning doctors need to keep an open mind as to what the injury could be.
Your medical history is vital since certain health conditions like uncontrolled diabetes or high blood pressure can increase the risk of complications like severe bleeding or infection. The doctors will also look into your eye health history to understand what kind of vision they can expect to preserve. They also need to know when you last had a tetanus shot.
To assess an eye trauma, a thorough examination must be done in order to understand the severity of the eye injury. This involves checking the vision, how well the pupils respond to light, and the pressure within the eyes. This is followed by more specialized tests including the slit-lamp test and examination of the back parts of the eye after using drops to widen (dilate) your pupil. Detecting signs of damage in the parts that support the eye’s lens, such as shaky lens, focal iris shaking, vitreous humor (jelly-like substance in eye) leakage, and lens displacement are crucial, although they may not always be present.
Signs of a subtle lens injury might be seeing the edge of the lens when looking in different directions, a displaced nucleus (center of lens) in a straight look, lens separated from the iris (colored part of the eye), or changes in the shape of the lens edge. A cataract developing within a few hours of the eye trauma could signal that the front part of the lens was breached.
Testing for Traumatic Cataract (Eye Injury – Cataract)
Surgery for traumatic cataracts is a tricky process, as it often involves the risk of additional issues like lens dislocation, capsular rupture, and loss of the vitreous, a gel-like substance found within the eye. This is generally due to damage to the lens capsule and zonules, the tiny fibers that suspend the lens within the eye.
Therefore, careful preoperative assessment and planning are key to successful surgical results. Sometimes, if other parts of the eye, such as the cornea, are opaque and obscure the view, computed tomography (CT) images can be helpful in recognizing a traumatic cataract. Capsular tears, which can occur together or separately, are often hard to spot using traditional B-scan ocular ultrasonography, as it does not provide a clear image of the posterior capsule or zonular structures. Instead, ocular echography, which uses a high-frequency sound wave, is a better tool for detecting hidden tears at the back of the eye’s lens capsule.
In addition, ultrasound biomicroscopy is useful for spotting hidden damage to the zonules in patients who have had trauma to the anterior, or front, segment of the eye. Ocular CT of the anterior segment and Scheimpflug imaging, which is a type of high-resolution photography, can also play a role in determining any existing or potential damage to the back of the lens capsule and zonules.
Exact calculations for the placement of an intraocular lens (IOL), an artificial lens that replaces the individual’s natural lens, may not be possible initially. However, surgeons can either use data from the damaged eye or the unaffected one, or delay the placement of IOL to a later procedure. Research shows that generally, the measurements attainable from the unaffected eye are reliable for most cases.
Treatment Options for Traumatic Cataract (Eye Injury – Cataract)
The type of anesthesia used during eye procedures should be chosen based on factors like the patient’s age, overall health, and the estimated duration of the procedure. General anesthesia is often used for serious eye injuries, complex procedures, patients who may have difficulty staying still, and for children.
Keeping the area free of bacteria and infection is crucial during these procedures. One way to reduce the risk of infection is by cleansing the eye with a 5% povidone-iodine solution.
Surgery to remove traumatic cataracts may not be recommended right away. The typical approach is to first repair any damage to the eye, followed by a separate procedure to remove the cataract and possibly insert an artificial lens. Delaying cataract removal can allow a more thorough evaluation of any related eye injuries, and can also take into account the severity of the cataract. Though quick intervention to remove the cataracts can improve vision outcomes, certain conditions can make immediate cataract removal more challenging.
It’s important to note that eye injuries in children can be severe and, in some cases, may be linked to child abuse. Any blockage to a child’s vision needs to be treated promptly to prevent vision problems in the future, especially in children under the age of 5. It’s recommended that surgery be performed within a year of a traumatic event; delaying can increase the risk of vision problems.
When damage to the eye also includes the cornea, there may be a cut or a lost section of the cornea – the clear front surface of the eye. These wounds may be sutured during the same surgical session as the cataract extraction. The fixing should be done carefully, especially in kids due to the elasticity of their cornea.
Instances where preexisting conditions exist in the eye also require careful decision making. Multiple factors, including the surgeon’s expertise and the specific conditions of the eye, need to be taken into account when considering the best approach for cataract removal.
Finally, the specific steps of the procedure should be selected carefully to suit the individual characteristics of the patient and the eye condition. In all cases, it is recommended to keep the parameters of the phacoemulsification surgery – a common cataract surgery – low, and adjust based on the situation. The artificial lens would be selected and placed based on the specific patient’s situation.
What else can Traumatic Cataract (Eye Injury – Cataract) be?
Traumatic cataract is a condition that always happens after a person suffers an eye injury, either recent or in the past. However, when diagnosing traumatic cataracts, doctors also need to consider and rule out a number of other conditions that can affect the eyes:
- Acute angle-closure glaucoma and Angle-recession glaucoma (types of eye conditions which causes damage to the optic nerve due to high eye pressure)
- Choroidal rupture (a tear in the eye’s choroid layer)
- Retinal detachment (when the retina separates from the back of the eye)
- Laceration of the corneoscleral complex (a cut or tear in the front part of the eye)
- Iridodialysis (a tear in the iris of the eye)
- Iridocyclitis (inflammation of the iris and ciliary body in the eye)
- Ectopia Lentis (a condition where the eye’s lens is not in the normal position)
- Hyphema (bleeding in the eye)
- Vitreous Hemorrhage (bleeding into the clear gel that fills the space between the lens and the retina of the eyeball)
- Age-related or senile cataract (a type of cataract that occurs as you age)
- Sudden vision loss
It is important for the doctor to consider these other conditions, and to perform necessary tests to reach an accurate diagnosis.
What to expect with Traumatic Cataract (Eye Injury – Cataract)
Blindness due to injury significantly impacts individuals and society. It’s vital to have standard protocols for classifying, examining, and treating such cases to improve results. In 1996, the Birmingham Eye Trauma Terminology (BETT) was introduced to provide consistent documentation for eye injuries. BETT makes it easier to track visual results after surgery for traumatic cataracts. However, many challenges and debates about managing traumatic cataracts persist.
Figuring out the potential visual results for patients with traumatic cataracts is intricate, as it depends on various factors. The Ocular Trauma Score (OTS), developed in the early 2000s, helps predict vision quality after eye injuries. Factors used in the OTS include initial vision, rupture, infection in the eye (endophthalmitis), perforating injury, detached retina, and a pupillary defect related to nerve response. A study of over 300 children showed that the OTS is effective in predicting visual outcomes in young patients. However, it’s still necessary to do more research to enhance its precision for kids.
The form of cataracts notably influences the surgical technique used and the visual outcome. However, medical experts have not reached an agreement whether to remove the cataract primarily or secondarily is the best approach.
Infections, including one in the eye known as endophthalmitis, are common after injury to the open globe of the eye, especially if a foreign object is left in the eye. Some plants with antimicrobial and antifungal properties might help prevent infection from penetrating injuries, like ones caused by a wooden object. A study found that vision results after managing traumatic cataracts were comparatively better in eyes with open injuries than those with closed ones.
Possible Complications When Diagnosed with Traumatic Cataract (Eye Injury – Cataract)
Traumatic cataracts can lead to various complications, which include intense inflammation in the eye, retina detachment, a break in the eye’s choroid layer, blood in the anterior part of the eye, bleeding behind the eye, damage to the optic nerve, the rupture of the outer layer of the eye, and multiple types of glaucoma such as congestive, unripe, growth blocking and angle-recession.
To prevent the retina from detaching, the displaced vitreous in the anterior part (the front section) of the eye needs to be removed. This can be achieved by making an incision from the side and performing an anterior vitrectomy, a procedure to remove the affected vitreous, with a second instrument. It is important not to use the phacoemulsification handpiece, an ultrasonic instrument employed in cataract surgery, to pull or apply heat to the vitreous, and not to attempt its removal through the wound with a sponge.
If bleeding occurs in the anterior chamber, it is crucial to promptly remove and irrigate it to prevent the mixing of blood and cornea (hematocornea), which can result in vision loss. During cataract extraction, techniques such as using a dispersive viscoelastic or intracameral epinephrine can be employed for controlling spontaneous bleeding.
Recovery from Traumatic Cataract (Eye Injury – Cataract)
After cataract surgery, patients usually have check-ups one day, one week, and one month after the operation. These check-ups aim to monitor patient’s progress and ensure they are healing properly. Patients are typically given medication for the eye such as antibiotics and anti-inflammatory drugs. If any complications arise, eye-specific steroid medication or medicine to lower eye pressure might be prescribed.
During these check-ups, an instrument called a slit-lamp is used to examine the eye and the doctor also checks the patient’s vision. This helps to identify any potential issues early and ensure proper recovery.
Children who have had cataract surgery and are at risk of a condition known as postoperative amblyopia, may benefit from having their unaffected eye covered during their recovery. There’s also a risk that they can develop a condition affecting the back surface of the eye’s lens, known as posterior capsular opacification. If untreated, this can also lead to amblyopia. For some young patients, their bodies may respond to surgery with inflammation causing a condition known as fibrinous uveitis. This can be managed by prescribing strong steroid medication around the time of operation.
Preventing Traumatic Cataract (Eye Injury – Cataract)
It’s extremely important to inform patients about the potential dangers of developing trauma-induced cataracts and the associated health issues that might follow. Patients should be urged to get medical care as soon as possible if they experience any injury to the eye. Moreover, patients need to understand the importance of wearing sunglasses to protect their eyes from harmful sun-rays, as well as how to use protective eyewear correctly while participating in activities that can pose a risk to their eyes.
