 Cataract formation is a common sequel to

blunt trauma.
Also associated with Subluxation ,dislocation

It is the most common cause of Unilateral

cataract in young individuals.
1 Penetrating trauma
2 Blunt trauma may cause a characteristic flower-shaped
opacity
3 Electric shock and lightning strike are very rare causes
that may result in anterior and posterior iridescent
opacities that have a stellate pattern
4 Infrared radiation, if intense as in glassblowers, may
rarely cause true exfoliation of the anterior lens capsule
5 Ionizing radiation for ocular tumours may cause
posterior subcapsular opacities that may develop months
or years later.
Postulated mechanisms
Traumatic damage to the lens fibres

Ruptures in the lens capsule

influx of aqueous humour

Hydration of lens fibres

OPACIFICATION
 A ring-shaped anterior subcapsular opacity may underlie a Vossius
ring [. Imprinting of iris pigment on anterior lens capsule]
 Commonly opacification occurs in the posterior subcapsular
cortex along the posterior sutures, resulting in flower -shaped opacity
[rossette] which may subsequently disappear, remain stationary or
progress to maturity.

 Cataract surgery may be necessary for visually significant opacity.

 Lens protein leak can lead to secondary Glaucoma,uveitis.
 Subluxation of the lens may occur,
 secondary to tearing of the suspensory ligament.
 A subluxated lens tends to deviate towards the meridian of intact
zonule
 the anterior chamber may deepen over the area of zonular
dehiscence, if the lens rotates posteriorly.
 The edge of a subluxated lens may be visible under mydriasis
 Trembling of the iris (iridodonesis) or lens (phakodonesis)
on ocular movement.
Subluxation to render the pupil partly aphakic may result in
Uniocular diplopia ; lenticular astigmatism due to tilting may
occur.
 Dislocation due to 360° rupture of the
zonular fibres is rare and may be into the
vitreous, or less commonly, into the anterior
chamber an underlying predisposing
condition should be suspected.
 A slowly progressive or stationary cataract
especially dense cataracts with a history of
ocular trauma should be removed if only visually
significant for the patient.

 Gross visual field defects,Afferent pupillary

defect, Sphincter tears,iridodialysis,elevated or
abnormal low IOP,angle anomalies ,ultrasound
evidence of posterior segment pathology should
be looked for by the surgeon.
 Visualization:
In case of corneal laceration /edema which
impairs ability to remove lens material –
Open –sky approach .

In case of Haemorrhage interfering with view

– OVDs /air is helpful
 Inflammation:

In case of synechiae,pupil seclusion,distorsion

- Gentle sweeping to dilate, pupilloplasty,
Peripheral iridectomy – to prevent pupillary
block.
- Cycloplegics , topical & oral steroid therapy.
 Primary IOL insertion when intraocular
inflammation and haemorrhage are minimal
and view of anterior segment structures is
good.
 Retained foreign matter:

Indirect ophthalmoscopy if view is clear.

Ct scan/Ultrasound if inadequate view
MRI if not metallic body.

Pars plana /anterior approach along with lens

implantation then PPV.
Irrigating solutions to dislodge foreign body
intracamerally.
 Damage to other ocular tissues:

In sphincter rupture ,distortion and

iridodialysis – Repair by suturing iris root to
scleral spur.
 Zonular dehiscence and dislocation:

- OVD tamponade of vitreous , Capsular

tension ring in capsular bag , removal of
cataract through Pars plana
- ACIOL .Transcleral fixated PCIOL
 A secondary (complicated) cataract develops as a result of some
other primary ocular disease.

 Chronic anterior uveitis

- It is the most common cause.
- Related to the duration and activity of intraocular
inflammation that results in prolonged breakdown of the
blood–aqueous and/or blood–vitreous barrier.
The use of steroids, topically and systemically, is important.
The earliest finding is a polychromatic lustre at the posterior pole
of the lens which may not progress if the uveitis is arrested. If the
inflammation persists, posterior and anterior opacities develop
that may progress to maturity. The opacities appear to progress
more rapidly in the presence of posterior synechiae.
 Acute congestive angle-closure may cause small, grey-white,
anterior, subcapsular or capsular opacities within the pupillary area
(glaukomflecken )– focal infarcts of the lens epithelium
pathognomonic of past acute angle-closure glaucoma.
 High (pathological) myopia is associated with posterior
subcapsular lens opacities and early-onset nuclear sclerosis, which
may ironically increase the myopic refractive error. Simple
myopia, however, is not associated with such cataract formation.
 Hereditary fundus dystrophies, such as retinitis pigmentosa, Leber
congenital amaurosis, gyrate atrophy and Stickler syndrome, may
be associated with posterior subcapsular lens opacities Cataract
surgery may occasionally improve visual acuity even in the
presence of severe retinal changes.
 THANK YOU.