Traumatic Cataract

How injury causes a cataract

The lens sits behind the iris and focuses light on the retina. It is enclosed in a thin capsule and made of precisely arranged proteins that must stay clear.

• Blunt trauma sends a shock wave through the eye. The lens can swell, its fibers can be disrupted, and a characteristic rosette (star-shaped) cataract may form. Iris pigment can be imprinted on the lens surface (Vossius ring).
• Penetrating injuries puncture the lens capsule, letting fluid enter and the lens turn white quickly.
• Retained metal fragments, especially iron or copper, release toxic substances that cloud the lens (siderosis or chalcosis).
• Electric shock and lightning damage lens proteins, sometimes months later.
• Radiation from radiotherapy or occupational exposure causes cataracts years later.

Symptoms

• Blurred, cloudy or dim vision in the injured eye
• Glare and halos around lights
• Double vision in one eye
• Faded colors
• A white or gray appearance in the pupil in dense cataracts
• Pain, redness and light sensitivity if inflammation or other injuries are present

Associated eye injuries

Traumatic cataracts often come with other damage that affects treatment and outcome:

Diagnosis

An ophthalmologist will:

• check vision and eye pressure
• examine the eye with a slit lamp, looking at the lens, its position and capsule
• dilate the pupil to examine the retina
• order ultrasound if the cataract blocks the view of the back of the eye
• order CT scan if a metal foreign body is suspected (MRI is avoided with possible metal)

Treatment

When to operate

• Immediately or within days if the lens capsule is ruptured with swelling, if lens material is causing glaucoma or inflammation, or during repair of a penetrating injury
• Later, once the eye has settled, if the cataract develops gradually and the eye has healed, which allows better planning and lens measurements

Surgery

The cloudy lens is removed, usually by phacoemulsification (ultrasound fragmentation) or other techniques, and an artificial intraocular lens (IOL) is implanted. Trauma can make surgery more complex because of weak lens supports, capsule tears or other damage. Surgeons may use capsular tension rings, place the lens in the sulcus, or fix it to the iris or sclera.

Other treatment

• Steroid eye drops for inflammation
• Pressure-lowering drops for glaucoma
• Retinal surgery if needed
• Antibiotics for infection risk with penetrating injuries

Children

Traumatic cataracts in young children risk amblyopia (lazy eye), so early surgery and patching or optical correction afterward are important.

Outlook

Vision after surgery depends on the severity of the injury and associated damage. Many people with blunt trauma regain good vision. Outcomes are less predictable after penetrating injuries, retinal damage or infection. Regular follow-up is needed because glaucoma can develop years later.

Prevention

Most eye injuries are preventable:

• Wear protective eyewear for sports such as racquetball, squash, basketball and baseball
• Use safety glasses for power tools, yard work, chemicals and DIY
• Use protective eyewear in workplaces with flying particles or radiation
• Keep fireworks away from children
• Wear seat belts

Frequently asked questions

What is a traumatic cataract?

It is clouding of the eye's lens caused by an injury, such as a blow to the eye, a penetrating wound, a metal fragment, electric shock, lightning or radiation. It can develop immediately or months to years after the injury.

How long after an eye injury can a cataract develop?

A traumatic cataract can form within hours if the lens capsule is torn, or develop gradually over months to years after blunt trauma, electrical injury or radiation. Any blurring in a previously injured eye should be checked.

Can a traumatic cataract be treated?

Yes. Cataract surgery removes the cloudy lens and replaces it with an artificial lens. Surgery may be more complex than routine cataract surgery because of other damage from the injury.

Will my vision return after traumatic cataract surgery?

Many people regain good vision, especially after blunt trauma. Final vision depends on other injuries to the cornea, retina or optic nerve. Penetrating injuries and retinal damage tend to have less predictable outcomes.

What should I do after an eye injury?

Get an eye examination promptly. For penetrating injuries, protect the eye with a shield and go to the ER without removing objects or pressing on the eye. For chemical splashes, rinse with clean water for at least 15 minutes and seek emergency care.