Any trauma to the eye that disrupts the normal architecture of the lens may result in the development of a traumatic cataract—a lens opacity. The mechanism behind cataract formation involves fluid infiltration into the normally avascular and acellular lens stroma. The lens may be observed to swell with fluid and become cloudy and opacified. The time course is usually weeks to months following the original insult. Cataracts that are large enough may be observed by the naked eye. Those that are within the central visual field may cause blurring of vision or distortion of light around objects (eg, halos).
Management and Disposition
No specific treatment is rendered in the emergency department for cases of delayed traumatic cataract. Most cases require routine ophthalmologic referral.
Traumatic cataracts are frequent sequelae of lightning injury. Advise all victims of lightning strike of this possibility.
Cataracts may also occur as a result of electric current injury to the vicinity of the cranial vault.
Leukocoria results from a dense cataract, which causes loss of the red reflex.
If a cataract develops sufficient size and “swells” the lens, the trabecular meshwork may become blocked, producing glaucoma.
Traumatic Cataract. This mature traumatic cataract is seen as a large lens opacity overlying the visual axis. A traumatic iridodialysis is also present. (Photo contributor: David Effron, MD.)
Traumatic Cataract. (A) This acute traumatic cataract is seen as a milky cornea at the time of injury. (B) Bedside ultrasound shows a collapsed anterior chamber and intraocular foreign body. (Photo contributor: Kevin J. Knoop, MD, MS.)