Traumatic cataract is commonly seen in children, young adult males, and soldiers. There are three main types, namely cataracts caused by blunt contusion, blast injuries, and penetrating eye injuries.

bubble_chart Etiology

After the lens is injured, especially by perforation, aqueous humor enters the lens through the rupture in the capsular membrane. Water-soluble proteins in the lens, particularly γ-crystallins, are significantly lost, glutathione levels markedly decrease, and DNA synthesis as well as cell division slow down. Following the opacification at the injured site, the lens rapidly hydrates, forming vacuoles and edema. The opacity quickly spreads to the peripheral parts of the lens, eventually leading to complete opacification of the entire lens.

bubble_chart Clinical Manifestations

(1) Contusion cataract

It can be caused by blows from fists, balls, or other objects hitting the eyeball. Contusion cataracts have various clinical manifestations, which can be divided into the following five types:

1. Vossius ring opacity: A ring-shaped opacity appears on the lens surface with 1mm-wide pigmentation. These opacities and pigment spots may gradually disappear after a few days but can also persist long-term.

2. Rose Flower-like cataract: After the lens is struck, its fiber and suture structures are damaged, causing fluid to move between the sutures and lamellae, forming radial opacities resembling a rose flower. This type of cataract may occur within hours or weeks after the injury, and some patients' opacities may resolve. Others may develop the cataract years later, often permanently. In patients under 30, lens opacities may remain unchanged for many years until worsening after age 50, leading to gradual vision decline.

4. Lamellar cataract: Due to compromised lens capsule integrity and altered permeability, superficial cortical opacities develop.

5. Total cataract: Severe contusion can rupture the lens capsule, allowing aqueous humor to enter the cortex, leading to complete lens opacity within a short time. Over time, the cortex may be absorbed.

In addition to traumatic cataracts, ocular contusion may also be accompanied by hyphema, angle recession, lens dislocation or displacement, elevated intraocular pressure, and fundus changes, exacerbating visual impairment.

(2) Cataract caused by penetrating injuries

In adults, penetrating cataracts are often seen in lathe and bench workers due to iron foreign bodies entering the eye. In children, they are commonly caused by knife, scissors, or toy injuries. The cataract may present as localized opacity or remain static, but in most cases, rupture of the lens capsule allows aqueous humor to enter the cortex, causing rapid lens opacity. This may be accompanied by iridocyclitis, secondary glaucoma, or intraocular infection.

(3) Cataract caused by blast injuries

Miners exposed to explosions or children injured by firecrackers may develop cataracts similar to those caused by penetrating injuries. Generally, ocular tissue damage is more severe in these cases.

The occurrence of traumatic cataracts is related to the severity of the injury. If the pupillary area of the lens is injured, vision loss occurs rapidly. Injuries to the lens behind the iris lead to slower vision decline. Extensive capsule damage may cause significant anterior segment inflammation or secondary glaucoma in addition to vision impairment. When examining patients with traumatic endogenous ocular diseases, careful attention must be paid to the presence of intraocular foreign bodies. Sometimes, scleral wounds are easily overlooked, leading to misdiagnosis.

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Iron is the most common intraocular foreign body. Iron fragments in the lens can cause localized cataracts. If the iron fragment is very small, it may remain in the lens for years without significant reaction. Iron oxidizes in the eye and gradually diffuses, forming ocular siderosis, including deposits in the cornea, iris, lens, and retina, eventually leading to blindness. The severity of ocular siderosis depends on the size and location of the intraocular foreign body. Larger or posteriorly located iron fragments tend to migrate toward the posterior segment.

In the initial stage [first stage], fine brownish-yellow spots appear beneath the anterior lens capsule, visible only after pupil dilation. In the late stage [third stage], brown iron rust spots form under the anterior capsule. In the advanced stage, lens fibers degenerate, progressing to total cataract. Eventually, the lens shrinks or dislocates due to ligament degeneration. Cataracts in siderosis occur because lens epithelial cells degenerate after absorbing iron, hindering new fiber growth. Even if the cataract is removed, vision recovery is slow.

(5) Lens chalcosis

If the copper content exceeds 85%, it causes significant damage to ocular tissues. Pure copper can lead to suppurative changes in the eye. Copper foreign bodies in the lens can result in white internal visual obstruction, while those in the anterior chamber can cause iridocyclitis. In the posterior pole, they can damage the optic nerve, retina, and choroid. The deposition of copper ions in various ocular tissues is known as chalcosis. When deposited in the Descemet's membrane of the cornea, it forms a blue-green ring (Kayser-Fleischer ring). The iris may turn light green, and multicolored particles may appear in the vitreous, with green pigmentation observed in the retina. The lens, due to copper deposition, develops a sunflower-shaped white internal visual obstruction, with rainbow-like changes in the pupillary area and a velvety surface. The posterior lens capsule may resemble green shark skin. Sunflower-shaped white internal visual obstruction does not severely affect vision. However, if a copper foreign body is detected in the lens, it must be removed as soon as possible. Even if the foreign body is encapsulated by tissue, it can still cause necrosis of ocular tissues and lead to blindness. This differs from iron foreign bodies in the lens.

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1. Drug therapy

2. Surgical treatment and intraocular lens replacement