1.

Complication of traumatic cataract

Lens dislocation, subluxation, phacolytic, phacomorphic, pupillary block, and anglerecession glaucoma; phacoanaphylactic uveitis
(Kevin M. Jackson, O.D., F.A.A.O., emedicine.medscape.com)
2. Onset of traumatic cataract after trauma incident
Any trauma to the eye that disrupts the normal architecture of the lens may result in the
development of a traumatic cataracta 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).
(Knoop et al., 2010. Atlas of emergency medicine,Mc Graw Hill.)
3. Lens disorder of trauma
Lens dislocation, subluxation, phacolytic, phacomorphic
(Kevin M. Jackson, O.D., F.A.A.O., emedicine.medscape.com)
4. Red eye in 7 days after trauma, what is it?

5. Examination on cataract.
Physical examination
Lens opacity
May have decreased visual acuity
Congenital : Leucoria, strabismus, nystagmus, associated conditions (Down &
Rubella syndrome)
Diagnostic test :
Visual quality assessment : Glare testing, contrast sensitibity.
Retinal/macular function assessment.
Lab :
Diabetic
(5 Minutes Clinical Consult)
6. What is the finding of lower eyelid?
7. The differences of traumatic cataract and other types of cataracts.
I. Sharp penetrating trauma:
In penetrating eye injuries the anterior lens capsule is the first to be affected. A large tear
in the anterior capsule leads to:
- Aqueous will enter into the lens. So that the lens matter will be swollen and cloudy.
- Lens matter will go to the anterior chamber causing phacoanaphylactic uveitis and
secondary glaucoma.
- If the lens is soft, it will be completely absorbed by aqueous.
- If the nucleus is hard it will remain causing persistent uveitis and secondary glaucoma,

so that the lens should be removed as early as possible.

II. Blunt trauma:

It can cause 2 forms of cataract:
1. Vossiu's ring:
The iris pigment at the pupillary border will be imprinted on the anterior lens capsule by
trauma causing a black ring at the anterior lens capsule. It does not affect vision.

2. Rosette shaped cataract (concussion cataract):

- Minute capsular tears occur at the posterior pole of the lens together with separation of
lens fibers along the posterior suture line. So that lens opacity takes the shape of the
posterior suture line giving the appearance of a rosette shaped posterior subcapsular
cataract.
- It affects vision markedly because it is near to the nodal point.
- It may be complicated by lens intumescence with pupillary block glaucoma.

(Dr. Tarek http://eyescure.com/)

8. Indication of operation in traumatic cataract?
Repair the globe if there are other injuries.
2. Evaluation of retinal and optic nerve functions.
3. The management of cataract depends on its type as following:
- Localized stationary cataract is left unless it is interfering with vision.

- If there is a large capsular tear we can do either:

* If the cataract is soft we can either do irrigation and aspiration, or leave it to be irrigated by
the aqueous undercover of steroids to treat uveitis.
* If it is hard, early cataract extraction should be done.
- Vossiu's ring requires no treatment.
- For rosette shaped cataract we do ECCE and IOL after the eye becomes quite.
4. Optical correction of aphakia.
(Dr. Tarek http://eyescure.com/)
9. The use of atropine in treatment?
Tropicamide

Single use eye drops.

Produces rapid-onset mydriasis of short duration, maximal effect after 40-60 minutes.
Recovery occurs over 6-8 hours. It produces some cycloplegia and is used to visualise the
fundus for short procedures.
Cyclopentolate Hydrochloride Longer duration of action, reaching its maximal effect in 30-60 minutes. This lasts for about
Eye drops.
45 minutes; complete recovery may take up to 24 hours. It can be used for visualisation of
the fundus, refraction studies, or in the treatment of iridocyclitis if the patient is allergic to
atropine
Atropine Sulphate
Atropine eye drops or single use eye drops.
Used to prevent posterior synechiae in uveitis and iridocyclitis. The effects of atropine can
last for up to 14 days. Systemic toxicity from atropine absorption occurs quite often,
especially in elderly or very young patients. In particular elderly patients may become
confused.
Phenylephrine Hydrochloride Single use eye drops.
Phenylephrine can be used alone or in conjunction with the other agents to produce wide
mydriasis.