Lens damage of a traumatic nature is usually divided into several types: cataract, subluxation or dislocation. The causes of injury to the lens, as a rule, are direct penetrating wounds, closed injuries (contusions), blow electric shockas well as ionizing radiation.

Trauma is the most common reason unilateral cataract in young and middle-aged people.

Signs of traumatic damage to the lens

Small ruptures of the capsule sac of the lens are often well tolerated and result in small segmental opacities that do not significantly affect vision. If the development of cataracts occurs weeks and months after the injury, then it can cause severe visual defects. Modern technologies for cataract removal are highly effective and give exceptional results, in the absence of damage to the cornea, macular (macula) and optic nerve.

If the operated eye is damaged in patients who have undergone previous cataract surgery with implantation of an intraocular lens, there is a risk of dislocation of this lens.

The lens is located behind the iris, attaching to the fibers of the ciliary girdle extending from the ciliary body. When closed injury eyes, the fibers of the girdle often break, which leads to partial dislocation (subluxation) or complete dislocation of the lens.

Diagnostics

When the lens is displaced (subluxation), its edge after dilation of the pupil can be seen, whereas with complete dislocation, the lens can be deployed to the anterior chamber or back to the retina.

Signs of divergence of the fibers of the girdle are clearly visible in the light of the slit lamp and look like a flickering of the iris with rapid eye movements. This condition is called iridodonez. The diagnosis is made after an extended examination under a slit lamp, or after the detection of appropriate signs when performing computed tomography.

Treatment

A slight subluxation of the lens does not impair vision, whereas in the case of more pronounced subluxations and posterior dislocations, spectacle correction is often required.

The need for surgical treatment occurs only in cases when there was a dislocation of the lens anteriorly with damage to the corneal endothelium or blocking the outflow of intraocular moisture through the pupil. This condition leads to an acute attack of angle-closure glaucoma. Direct significant damage to the lens, resulting in inflammation of the eye, damage to the corneal endothelium, or an increase intraocular pressure, in most cases, requires lens extraction. The procedure can be performed primary or secondary, depending on the severity of the injury, the choice of the surgeon (visibility), and other dependent factors.

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Traumatic cataract, extremely dangerous disease eye. Occurs with blunt or acute penetrating wounds eyeball, its various structures, as well as in case of burns and radiation.

In case of an unfavorable course and untimely treatment, the probability of developing complete blindness reaches 70%... This type of cataract is most common among young people and middle-aged people. With loss of vision, the disease leads to disability.

What is traumatic cataract, causes of occurrence, ICD code 10

By International classification diseases ( ICD-10), traumatic cataract was assigned the code H26.1.

There is no single set of characteristics that takes into account all the factors of this type of disease.

The degree of progression of the disease depends on the rate of damage to the eye: either a slow course or a fast one. In some cases, cataracts may not progress.

Kinds

• mechanical, penetrating and contusion;
• chemical (toxic);
• beam;
• professional.

Contusion cataract occurs either immediately after injury, or a little later. There are many subspecies of the disease, but the main ones are:

• Fossius annular cataract. It is characterized by clouding of the front of the lens, most often with blunt eye trauma. A pigmented ring is formed on the front of the lens, consisting of cells from the rim of the pupil. Resorption of this ring may take several weeks or months.
• Rosette contusion cataract... Strip-like opacities are formed, collecting in the center of the rosette. Vision deteriorates gradually.
• Total cataract. It is characterized by rupture of the lens capsule or its contusion. The forecast is the most unfavorable.

Important! In mild cases of annular and rosette cataracts, it is possible self-healing of the eye and restoration of its functions.

Types of chemical traumatic cataracts are divided according to the type of substance that caused the damage. These include:

• Alkali burn. In the case of a burn with a similar substance, the damage to the eye is not instantaneous, the pathology develops gradually.
• Acid burn. Acid has a very aggressive effect on tissues, so the pathology manifests itself instantly, immediately after the substance enters the organ of vision. Not only the eyeball is affected, but also nearby tissues.
• Burn and intoxication with other substances.Eye damage may disappear over time. When the whole organism is intoxicated, the motor function of the eye is disrupted, and the symptoms are associated with general poisoning.

Photo 1. Burns of the eye with acid, as a result of which cataracts appear immediately. To remove it, surgical intervention is required.

Radiation cataract does not develop instantly, the period of manifestation may last over 10 years. The lens of the human eye is sensitive to X-rays, infrared radiation, microwave waves. The peculiarity of this type of lesion of the lens is the appearance of colored waves on a gray background.

Professional cataracts are caused by working with heat sources, with objects from which a foreign body may enter the eye, for example, with a welding machine.

If the lens is damaged eyeball fluid gets into it and its functioning is disrupted. This is often accompanied by a displacement of the lens from its place - dislocation or subluxation. The ingress of a foreign body or liquid into the eye further complicates the course of the disease. Injury more than 3 mm, especially complicated by displacement, cannot overgrow itself and the patient needs urgent health care.

Attention!Most traumatic cataracts are accompanied by a change several structures eyeball.

Diagnostics

With a timely visit to an ophthalmologist, the identification of the cause of the disease and its diagnosis do not have any difficulties. The first action of a specialist is fundus examination the patient. In some cases it is used biomicroscopy of the eye... The deepest parts of the fundus are examined using a light lamp. Additionally, a microscope is used. This method is completely painless and helps to see the whole picture of the injury.

Treatment

Traumatic cataract treatment is carried out only by surgery in both adults and children.

Surgical intervention is possible when stopping inflammatory processes after injury, it usually takes from 4 months to one year... The operation is performed one or two years after the injury.

In some cases, the traumatic cataract is removed urgently. This happens when wound treatmentand finding extensive damage (rupture) of the lens... In such cases, surgery reduces the risk of other deformities, complicated inflammation and extremely long healing.

Important! Children undergo surgery under general anesthesia.

Surgical options for post-traumatic cataract of the eye

• Extracapsular extraction. The oldest surgical method. The lens is removed without a capsule. The remaining capsule subsequently serves as a natural protection for the implanted lens. This type of surgery is traumatic and requires long-term rehabilitation.
• Intracapsular extraction. Removal of the lens with a capsule. This includes operations such as cryoextraction, vacuum and forceps extraction. Requires a long recovery and healing of stitches.

Photo 2. Operation of intracapsular extraction: under the letter A (left) is a schematic image, under B (right) is a view during the operation.

• Ultrasonic phacoemulsification.With the help of ultrasound, the lens is transformed into an emulsion, which is removed through a system of tubes with minimal losses to the eyeball. The safest way to treat traumatic cataracts.

Reference.During cryoextraction, the front part of the lens is frozen to the tip of a special instrument, in this way it is removed from the eyeball.

After removing the lens, the patient is implanted in its place artificial lens... There are two types of lenses - hard and soft. With ultrasonic phacoemulsification, soft lenses are implanted; this is a modern and safe option for restoring vision. Rigid lenses require suturing and rehabilitation for up to six months.

The most modern lens option that allows you to see objects both near and far - phakic intraocular lenses.They do not require correction with glasses. For the safety of children and their full development, the most modern methods of surgery are recommended.

Complications

After the operation has passed, the doctor prescribes certain medications and regimen, allowing the body to get used to the artificial lens as safely and quickly as possible.

In case of ultrasonic phacoemulsificationonly at 10% of patients there are complications associated with a weak ligamentous apparatus of the lens, concomitant eye diseases, with systemic ailments, for example, diabetes. In the case of suture surgery, complications can be caused by injury during the operation and non-compliance with the doctor's recommendations after the intervention.

Traumatic cataract is the most common consequence of penetrating wounds of the anterior segment of the eyeball.

The nature of the change in the lens in different cases perforated wounds are different. For example, partial opacity of the lens has almost no effect on the course of the wound process, while complete destruction of the lens itself can lead to the death of the eye.

Cataracts with damage to the eye are divided into:

• traumatic;
• contusion;
• burns;
• beam.

According to the degree of progression of cataracts:

• stationary (non-progressive);
• slowly progressing;
• rapidly progressing, causing an increase in intraocular pressure and not causing an increase in intraocular pressure.

According to the state of the lens capsule:

• without breaking the capsule;
• with rupture of the capsule;
• destruction of the lens.

By the presence of a foreign body that caused an eye injury:

• without foreign body;
• from foreign body.

In case of eye injuries, the lens may be displaced, therefore, this factor is taken into account.

Damage to the lens of the eye with the development of partial stationary cataract is possible with injuries caused by the ingress of very small foreign bodies into the eye.

When even a very small iron-containing fragment is introduced into the lens, a progressive clouding of the lens usually begins after 2-3 months.

Only in cases where the foreign body is an alloy of iron with chromium, nickel, or is another non-oxidizing alloy, the formation of a partial non-progressive cataract is possible.

Partial non-progressive cataracts can also be the result of injuries with an awl, pen, nail and other piercing objects. The development of such a cataract in the peripheral parts of the lens rarely affects the function of the eye.

When opacities are located in the optical zone of the lens, the latter lead to a significant decrease in visual acuity.

Slowly progressive lens opacity is observed in cases where the integrity of the lens capsule is preserved or slightly damaged, and cataract is a consequence of contusion.

With a significant size of the lens wound or with its complete destruction, a rapid progression of opacities develops, accompanied by swelling of the lens fibers with an increase in their volume. This can cause an increase in intraocular pressure and aggravate the course of the disease.

As a result of contusion of the eye, the lens is often displaced (subluxation and complete dislocation). Displacement is possible into the anterior chamber and vitreous humor.

Contusion of the eye can lead to the development of specific contusion cataracts, for example, Fossius' annular cataract. It is observed with contusion or penetrating injury to the eye, but without violating the integrity of the lens capsule. The opacity looks like a delicate ring; it usually develops in young people. It is, in essence, not a cataract, but the deposition of pigment of the pupillary edge of the iris on the anterior lens capsule. This phenomenon is reversible. It resolves within a few weeks or months.

Contusion of the eye can lead to the formation of rosette cataracts - these are banded subcapsular opacities of the lens fibers, diverging in the form of petals.

The formation of cataracts during rupture of the lens sac is explained by the access to the inside of the lens of aqueous humor containing proteolytic enzymes. They, in turn, cause swelling, degeneration of opacities and partial resorption of the lens masses.

Traumatic cataract develops after an eye injury. Damage to the visual apparatus can be blunt, penetrating, or burned. Traumatic cataract leads to visual impairment up to blindness.

Cataract is a clouding of the lens, loss of transparency. A traumatic type of cataract is caused by a damaging factor. Symptoms can occur immediately or gradually progress.

Classification of post-traumatic cataract by the nature of the damage:

• contusion - from impact (ring-shaped, rosette, total);
• wound - from a penetrating wound (with or without a foreign body);
• toxic - from chemical damage (burns with alkali, acid, the consequences of general intoxication of the body);
• radiation - from ionizing radiation.

By the amount of damage to the capsule:

• without damage;
• there is a gap;
• destruction of the lens.

By localization of the lens after injury:

• natural position without displacement;
• subluxation of the lens;
• dislocation into adjacent structures.

As well as traumatic cataract, according to the rate of development of symptoms and morphological changes, it is divided into rapidly and slowly progressive, stationary.

Traumatic cataract refers to, since it is almost always accompanied by damage to other structures visual organ... The combination of damage to several structures affects the course of the operation and the recovery period.

Causes and symptoms

The following causes can lead to traumatic damage to the natural lens of the eye:

• blunt impact trauma;
• penetrating wound with a sharp object;
• chemical burn;
• toxic intoxication lesion;
• ionizing radiation;
• a combination of several reasons.

The clinical manifestations will depend on the cause as well as the extent of the injury. It is believed that the most unfavorable prognosis after eye contusion from a stroke - up to 70% of cases lead to blindness.

Common symptoms of traumatic cataract:

• blurred vision, blurry;
• increased photosensitivity;
• doubling of objects;
• bright circles above illuminated objects;
• flashes before the eyes;
• less vivid vision of the picture;
• improving the quality of vision in cloudy weather;
• whitish pupil;
• increased IOP;
• complete loss of vision.

If the capsule is damaged, then the moisture of the anterior chamber penetrates into the lens substance. It begins to absorb moisture, swell, which leads to destruction and inflammation.

A small capsule rupture of up to 2 mm is capable of self-regeneration. Traumatic cataract without swelling is possible with an intact capsule.

When a metallic substance enters the eye, siderosis develops. The disease is manifested by the development of small rusty spots. They are positioned like a necklace under the front capsule. The loss of transparency occurs after a few months.

Diagnostics

After an eye organ injury, a full examination of the visual apparatus is required with an assessment of not only morphological, but also functional changes:

• asking a person about the details of the injury;
• external examination;
• assessment of the deeper structures of the eye using gonioscopy, biomicroscopy and ophthalmoscopy;
• determination of acuity and visual fields (visometry, perimetry);
• measurement of intraocular pressure (tonometry);
• assessment of refractive function, characteristics of the cornea using computerized keratorefractometry and keratotopography;

A full range of diagnostic activities necessary to identify damage at all levels. This will allow you to choose the best treatment option.

Treatment

Only effective method traumatic cataract treatment - surgical removal. It is customary to carry out the operation as the inflammatory manifestations subside, but sometimes it is carried out during the initial admission of a person to the hospital.

Lens removal operations:

1. ... The essence is to bring the clouded lens into an emulsion using ultrasound. Then the destroyed parts of the lens are removed.
2. Intra or extracapsular extraction - surgical removal of a traumatic cataract with or without a capsule.

After removing the lens, an intraocular lens (IOL) is placed. The timing of the operation and the IOL installation are determined on an individual basis.

Operations to replace a clouded lens are widespread in ophthalmology. They are carried out quickly, require small restrictions, and the risks of complications are low. Follow the doctor's recommendations, do not self-medicate. Traumatic cataract definitely requires medical attention.

Additionally, see how the operation is performed for traumatic cataract:

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Traumatic cataract usually caused by mechanical damage to the lens, as a result of which intraocular fluid penetrated into the lens capsule.

As a rule, damage to the lens is accompanied by damage to other structures of the eye - the cornea, iris, etc., therefore, surgical treatment includes manipulations not only on the lens, but also on the adjacent structures of the eye. Traumatic cataracts also include lens opacities caused by burns eyes and the action of ionizing radiation.

Symptoms

At the site of injury, opacity occurs, gradually spreading to the entire lens. With minor damage to the capsule, sometimes the defect closes and a small local area of \u200b\u200bopacity is formed.

Cataracts are often the result of blunt trauma to the eye and lens. It is called contusion cataract. As a result of contusion, at the beginning, opacity occurs in the center of the lens, then it spreads to the posterior capsule, and then to the entire lens. However, more often than not, opacity affects only part of the lens. Sometimes, with a large impact force, the lens capsule can completely rupture, in which case the opacity after injury captures the entire lens

Diagnostics

If the integrity of the lens is damaged, a cataract is detected immediately after injury. Very rapid swelling of the lens substance is possible, causing a sharp increase in intraocular pressure and the development or exacerbation of anterior uveitis. Only sometimes the cataract does not progress, for a long time or permanently limited to the initial opacity. In the variant when there is no direct damage to the lens, cataract often develops not immediately, but after some, sometimes distant (up to several months and years after injury or radiation) period; matures slowly.

Treatment

Treatment -. In the case of rapid swelling of a traumatic cataract or, on the contrary, a long development of opacity, as well as depending on other factors (for example, the presence of a traumatic cataract in the better seeing eye), surgical intervention is not postponed.