Traumatic cataracts differ from senile cataracts, concurrent cataracts, and metabolic cataracts in that they are caused by direct or indirect mechanical injury. Due to the diverse circumstances of trauma, the condition and prognosis of traumatic cataracts are also diverse.
Symptoms: Vision loss
This is the most obvious and important symptom of traumatic cataract. In particular, clouding of the central part of the lens can seriously affect vision, even if it is small and mild, because it blocks light from the visual axis. In addition, traumatic cataracts are often combined with intraocular hemorrhage, corneal damage, lens subluxation, glaucoma, and even severe cranio-cerebral injury, which are also common causes of vision loss.
How is vision loss caused?
Any lesion located within a person’s visual pathway can cause vision loss, including the cornea, lens, retina, optic nerve, and visual center. In contrast, most vision loss in patients with traumatic cataracts is caused by two or more factors.
Is vision loss always caused by cataract?
No, it is not. Any lesion located in the visual pathway can cause blurred vision, including the cornea, lens, retina, optic nerve, and visual center. In contrast, most of the vision loss in patients with traumatic cataracts is caused by two or more factors, and it cannot be said that all of them are caused by cataracts.
Disease
1.The concept of the disease
Traumatic cataracts are caused by direct or indirect mechanical damage to the lens, resulting in cloudy changes. Traumatic cataracts are divided into blunt contusion cataracts (where the eye is not broken) and penetrating cataracts (where the eye is broken). Most cataracts in this category occur in young and middle-aged groups prone to trauma, and their morphologic features are intricate due to the complexity of the injury. Most cases are associated with a clear history of trauma, but special attention needs to be paid to traumatic cataracts in groups such as infants and children who are unable to clearly articulate the process of injury.
2. Onset of the disease
Adults often complain of a significant loss of vision after the injury; in infants and young children, the early stage may be accompanied by abnormal crying, and if the injury is not noted, the child may gradually develop a white pupil area or strabismus.
A few issues you need to know.
(1) Eye diseases with significant loss of vision after trauma are usually combined with damage to other tissues of the eye, such as the retina and optic nerve
(2) The manifestation after injury may be very rapid or may occur gradually and slowly, depending on the degree of trauma
(3) Damage to the suspensory ligament of the lens (understood as the stent of the lens) may be combined, affecting future cataract surgery and IOL implantation.
(4) Most medications are ineffective and usually require surgery.
(5) For people with unclear expressions, there may be a history of potential trauma, which requires careful questioning or observation
(6) Unexplained monocular cataracts in young people suggest a history of suspected trauma or even intraocular foreign bodies
(7) Cataracts caused by trauma, especially penetrating trauma, have a high risk of combined ocular infection in the early stage, so the timing of cataract surgery needs to be carefully observed and judged by the doctor.
Common misconceptions of the public (mistrust due to lack of understanding) and their interpretation
(1) Neglecting the history of minor trauma, especially in infants and young children, can easily cause amblyopia and thus delay treatment; some people in high-risk occupations (often engaged in occupations such as lathe or metalworking that can easily cause small foreign objects to splash into the eyes) also tend to neglect the history of minor trauma and often do not notice it until their vision is significantly reduced.
(2) The possibility of later lens clouding or even dislocation is overlooked in ocular trauma where early vision loss is not obvious.
(3) In most cases, vision cannot be restored to its pre-injury state. Patients may think that their eye vision can be fully restored with cataract treatment or one surgery, ignoring the effects of more serious other eye injuries on vision, such as damage to the cornea, retina, optic nerve and traumatic glaucoma, etc. For example, if the corneal wound is in the center, even if cataract surgery is performed, vision recovery will often not be ideal later due to scars on the optical pathway.
(4) If cataract surgery is performed, IOLs must be implanted at the same time, but in fact, due to different eye conditions, doctors may choose to perform the surgery in stages, removing the damaged lens first and then implanting an IOL later when the eye condition is stable.
3. Common reasons for delayed treatment of the disease
It occurs mostly in people with unclear expressions: infants and young children, people with mental retardation, and small, easily ignored injury processes, or the slow onset course of blunt contusion cataracts.
A few issues you need to know (to pave the way for the next misconceptions to be deciphered)
(1) When infants and children have a white glance or develop strabismus, they should go to the hospital promptly for examination
(2) For people who are incapable of taking care of themselves, careful examination is also necessary when they develop blurred vision or strabismus.
(3) For people in high-risk occupations, it is best to go to the hospital for examination if you feel a history of suspicious trauma.
(4) The treatment of traumatic cataract should be combined with the treatment of other eye injuries.
Interpretation of common misconceptions of the public (mistrust due to lack of understanding).
(1) Neglecting the history of suspected trauma in special populations (infants and young children, mentally challenged people, and high-risk operators), and delaying the best time for treatment.
(2) Thinking that vision can be restored immediately after treating traumatic cataract: In fact, after treating traumatic cataract, treatment of other combined injuries of the eye is also needed, which often cause more damage to vision and most of them are irreversible, especially traumatic glaucoma and optic neuropathy, some of which do not manifest immediately in the early stage of the injury and need to be followed up and observed to avoid delays.
(3) worry about surgery, want to use medicine conservative treatment, miss the best treatment time
4 . Manifestation of disease
Blunt contusion cataract: Mostly caused by boxing, ball or other objects hitting the eye, atrial water conduction makes the external force act on the inelastic lens and also produce rebound on the vitreous surface, so blunt contusion causes lens clouding with diversity, it can be partial clouding or clouding of the whole lens. In blunt contusion cataracts, in addition to clouding, the lens itself is prone to be combined with disconnection of the suspensory ligament, as well as traumatic glaucoma (mostly associated with atrial angle recession), retinal injury (traumatic retinal detachment, retinal shock injury, etc.), optic neuropathy, and other ocular injuries.
Penetrating injury cataract: The penetrating injury of the eye simultaneously ruptures the lens capsule membrane, and atrial water enters the lens, causing fiber edema, degeneration and clouding. If the perforation is very small it may close on its own so that the lens develops a small confined clouding that does not progress further. However, after the lens capsule is broken, most people develop rapid cortical clouding. Large perforations may also cause secondary glaucoma due to excessive expansion of the lens cortex. In addition, this type of traumatic cataract has a high risk of combined intraocular infection and intraocular foreign bodies.
A few things you need to know (to set the stage for the next misconceptions to be explained)
(1) Sometimes other hidden injuries in the eye can be more damaging to vision than cataracts, such as damage to the optic nerve and high intraocular pressure.
(2) Rupture of the posterior lens capsule and dissociation of the suspensory ligament can greatly increase the complexity and risk of cataract surgery, and the prognosis for vision is often worse.
(3) Traumatic cataracts, especially penetrating cataracts, require attention to the development of intraocular infection, as its effects on the eye are often catastrophic.
(4) Traumatic cataracts, especially penetrating cataracts, require exclusion of the presence of intraocular foreign bodies, and routine orbital radiographs are recommended, otherwise the consequences can be serious.
Interpretation of common misconceptions among the general public (mistrust due to lack of understanding).
(1) If traumatic cataract is treated, vision will be better: In fact, the presence of traumatic cataract affects the surgeon’s observation of the back of the eye, and patients need to continue observation follow-up (such as ultrasound and intraocular pressure) after surgery to prevent the effect of other eye injuries on vision.
(2) Cataract surgery with simultaneous IOL placement as a matter of course: In fact, the integrity of the suspensory ligament and posterior capsule has a significant impact on the manner and outcome of the surgery, and patients are likely to fail to have an IOL placed during their first cataract surgery due to the integrity of the suspensory ligament and or posterior capsule.
(3) Traumatic cataract eye inflammation is a minor problem that can be treated with medication: In fact, it is important to pay attention to the impact of this infection on vision because many times, due to the strong virulence of the infected bacteria and the fact that the broken lens protein or detached vitreous is a good culture medium for bacteria, this infection can easily and quickly form an endophthalmitis that affects the whole eye and requires complex vitrectomy treatment, and the vision The prognosis is also greatly reduced.
(4) Why do I need to take a film if I think I only have a traumatic cataract? In fact, this examination is very important and may also require orbital CT or MRI if necessary. The missed intraocular foreign body is an important cause of infection and, in the case of copper or iron foreign bodies, may also produce copper or iron deposits that can cause irreversible visual impairment. Routine postoperative ocular ultrasound is also recommended to further rule out foreign bodies and other damage to the eye.
5, Diagnosis of the disease
In most cases, with a clear history of trauma and clouding of the lens, the diagnosis is not difficult, relying on history and slit lamp examination, orbital radiography and ultrasound, etc. For complex foreign bodies, orbital CT or MRI may be required, and sometimes ultrasound biomicroscopy (UBM) to determine the status of the suspensory ligament and intraocular pressure to clarify comorbidities. The presence of comorbidities may also be determined by UBM to determine the status of the suspensory ligament and IOP. Each of these tests focuses on a particular aspect of the eye and should not be relied upon too heavily. In some cases of insidious traumatic cataracts, dilated pupils may be required, and in the case of small, insidious suspensory ligament dissections, the patient will need to cooperate with the physician and sometimes repeat the examination.
A few questions you need to know (to set the stage for the next misconceptions to be deciphered)
(1) It is important to rule out foreign bodies in traumatic cataracts, which may require orbital x-ray foreign body radiographs, ultrasound, and possibly even UBM, orbital CT or MRI.
(2) UBM can suggest a lot of information about the suspensory ligament, which can help in the selection of surgical options.
(3) Ultrasound and IOP examination are practical and important for the initial exclusion of combined ocular injuries other than cataracts.
Explanation of common misconceptions (mistrust due to lack of understanding) among the general public:
(1) Why do we need to check so many things, can’t we just take a film? In fact, intraocular residual foreign bodies are extremely dangerous, and each examination modality has certain limitations, so for complex foreign bodies, sometimes even multiple examinations such as orbital X-ray foreign body photography, ultrasound, UBM, orbital CT and MRI need to be performed simultaneously to determine their location and size.
(2) Is this doctor trying to earn more money from me and why did he prescribe UBM examination? The condition of the suspensory ligament is not clear, and the IOL may not be stable even after implantation, or even fall into the vitreous cavity, requiring a larger and more complicated vitrectomy, and then suffer not a little. In contrast, UBM can check the condition of the suspensory ligament of the lens, which can help in the rational selection of the surgical plan.
(3) Why is it necessary to check ultrasound and IOP so many times after cataract surgery? Some combined eye injuries after trauma occur slowly and insidiously, and these two are the most important routine examinations in ophthalmology, which are effective and helpful to detect many problems, such as infection, retinal condition, vitreous hemorrhage, glaucoma, etc.
6 , treatment of the disease
After the diagnosis of the disease, surgery is preferred. The surgical plan depends on the lens suspensory ligament, posterior lens capsule, retinal condition, the presence of co-infection, intraocular pressure and other indicators, and the cataract surgeon will make a comprehensive assessment and give the best treatment timing and plan. When the limited clouding of the lens does not affect vision much, it can be further observed without special treatment. If the inflammation cannot be controlled or the IOP continues to rise, cataract surgery should be performed in a timely manner.
What you need to know (to set the stage for the next misconceptions)
(1) The timing of surgery for traumatic cataract should be based on the recommendation of your cataract surgeon.
(2) Surgical options for traumatic cataracts are quite complex and vary depending on the condition, and need to be evaluated by the cataract surgeon based on a comprehensive assessment of the examination results.
(3) Infection and elevated intraocular pressure are the greatest risks of traumatic cataract surgery.
(4) Traumatic cataracts are not always implanted with an IOL at the first surgery.
(5) Even if the IOL is implanted in two separate procedures, the surgical approach to implantation may vary depending on the amount of posterior capsular membrane left behind, and may be as simple as implanting an IOL or as complex as a scleral suspension.
Interpretation of common misconceptions (mistrust due to lack of understanding) (some questions frequently asked by patients and their families):
(1) Traumatic cataract occurs and requires immediate surgery: Most traumatic cataracts (especially those with cortical overflow and resulting in elevated intraocular pressure) require early surgery, but for lenses with insignificant clouding or limited clouding, observation and follow-up can be performed first.
(2) When traumatic cataract surgery is performed, an IOL should be implanted immediately: sometimes, depending on the inflammatory condition of the eye, the different integrity of the posterior capsule, and the status of the suspensory ligament, traumatic cataract may require separate cataract extraction and IOL implantation.
(3) IOL implantation for traumatic cataracts is as simple as opening cataracts in the elderly: most traumatic cataracts are combined with other injuries in the eye, and the surgery is much more complicated. Each case of traumatic cataract is different due to the state of injury, not to mention the comparison with geriatric cataracts.
(4) Vision will be improved immediately after traumatic cataract surgery: most traumatic cataracts are combined with other injuries in the eye, and the combined injury of any one of the cornea, retina and optic nerve will affect the final vision prognosis, and there is often a state that the vision is only a little brighter after surgery, but the improvement of vision is not obvious.
(5) When traumatic cataract is operated, the treatment is finished: The removal of traumatic cataract is beneficial for doctors to better clarify other injuries in the back of the eye, it does not mean that the surgery is over and the treatment is finished, on the contrary, many treatments may have just started.
7 .Prognosis of the disease
The prognosis of traumatic cataract depends mainly on the severity of the trauma, whether the injury is treated promptly, and whether there are complications such as combined infection, retinal detachment, glaucoma and optic nerve atrophy.
What you need to know about cataracts (to set the stage for the next misunderstanding)
(1) The prognosis of traumatic cataract mainly depends on the severity of the trauma, whether the injury is treated promptly, etc.
(2) Following the advice of a cataract surgeon can help improve the prognosis of traumatic cataracts.
(3) The prognosis of traumatic cataract is greatly affected by other ocular comorbidities such as infection, retinal detachment, glaucoma, and optic nerve atrophy.
(4) Mild traumatic cataracts may have a good visual prognosis if they are not combined with other serious ocular injuries.
(5) Traumatic cataracts may have a higher risk of posterior cataracts and require later laser treatment.
Interpretation of common misconceptions among the general public (mistrust due to lack of understanding).
(1) If you have traumatic cataract, you will be fine as long as you have surgery:Traumatic cataract is often combined with damage to other tissues of the eye, cataract surgery is only a part of the repair, and the reconstruction of the overall eye function is often complex and long.
(2) After cataract surgery, vision must be restored as before: traumatic cataracts often combine damage to other tissues of the eye, such as damage to the combined cornea, fundus retina and optic nerve, and the restoration of vision also depends on the treatment and recovery of these combined damaged tissues. In most cases, the condition of an injured eye is not comparable to that of an uninjured eye.
8. Follow-up and referral
After surgery is completed and the eye is stable, further correction of residual astigmatism, nearsightedness or farsightedness may be required.
A few questions you need to know (to set the stage for the next misconceptions to be explained)
(1) Regular review is beneficial to improve the prognosis.
(2) Some patients may develop late post-traumatic IOP elevation and retinal detachment, more affirming the significance of follow-up.
(3) In addition to visual acuity, IOP and fundus examinations should be performed on the review.
(4) After the surgery, depending on the astigmatism and residual myopia or hyperopia, it may be necessary to find a refractive surgeon for further treatment with frames or contact lenses and, if necessary, laser surgery.
Interpretation of common misconceptions of the public (mistrust due to lack of understanding).
(1) Why does the doctor keep asking me to go for a review? It’s too much trouble: Some injuries are not immediately manifested after trauma, such as retinal detachment and elevated intraocular pressure, and the patient himself may not easily notice these secondary changes in the state of pain and blurred vision caused by trauma, which further increases the damage to the eye. Therefore, it is essential to review the eyes regularly at the doctor’s office.
(2) I obviously had my cataract opened and removed, why is my vision decreasing again? Is it because the surgery was not done properly: Some injuries after trauma do not manifest immediately, such as retinal detachment and elevated intraocular pressure, and eyes after traumatic cataract surgery are also more prone to clouding of the posterior capsule due to the obvious state of intraocular inflammation, and the presence of these conditions may cause postoperative vision loss.
(3) Is it enough to look at the eye and IOL each time of review without those examinations? No. Some secondary changes after trauma may not manifest themselves immediately, such as retinal detachment and elevated intraocular pressure, so at least close follow-up ultrasound and intraocular pressure are needed, and patients need to follow the doctor’s advice in a concerted effort to maximize the recovery of postoperative visual function.
(4) There is always a foreign body sensation after eye surgery, is it because the surgery was not done properly? (4) Is the surgery not done properly?
9 .Patients and doctors
Doctors and patients should be comrades on the same front when facing diseases, and our common enemy is the disease. Especially for complex diseases like traumatic cataract, close cooperation between doctors and patients is needed. Many times the damage to the eye from trauma is irreversible. Through the treatment of traumatic cataract, doctors and patients work together to maximize the portion of vision that may be restored.
Interpretation of common misconceptions of the public (mistrust due to lack of understanding).
(1) Doctors always want to prescribe tests and drugs to earn my money: Please understand the true goodness of doctors’ hearts behind the currently misinterpreted doctor-patient relationship. The common enemy of doctors and patients is disease, and patients can only be better treated with the scientific guidance and help of doctors.
(2) Is it that the doctor’s level is not good if the vision improvement is not obvious after cataract opening: The vision recovery after traumatic cataract surgery depends on more factors, such as restoration of corneal transparency, absorption of blood accumulation in the vitreous cavity, recovery of retinal edema, etc. This is very different from the vision recovery of ordinary age-related cataract surgery, and the two cannot be compared.
Support Us
If the above content has been helpful to you, please click the share button to share the article or website. This is the greatest support for us.
Discussion
Share your experience, or seek help from fellow patients.
