Traumatic Cataract

Traumatic Cataract
SYMPTOMS Decrease in vision, Monocular diplopia, Glare, Halos around light
SIGNS Typically unilateral | Feathery linear opacities on the anterior and/or posterior capsule (Early form of a traumatic cataract), Petaloid or rosette-shaped opacification of the anterior and/or posterior cortex (Late form of a traumatic cataract), Vossius ring, Possible phacodonesis, Possible anterior capsule rupture, and Possible subluxation
Other ocular signs of trauma may be present as well including a subconjunctival hemorrhage, hyphema, torn iris, choroidal rupture, etc
WORK-UP Pupils | EOMs | Full eye exam with dilation | B-scan ultrasound (especially if cataract is dense) | Potential acuity measurement (PAM)
TREATMENT If not affecting vision and there are no other lens complications associated with trauma, monitor
If visually significant/affecting ADLs and/or there are other lens complications such as subluxation, refer to a cataract surgeon for further evaluation and surgery
FOLLOW-UP If monitoring, see patient back in 6-12 months
If referred to cataract surgeon: follow up for post-op care
ADDITIONAL LAB | TESTS None, although lab tests such as orbital CT may be ordered for other ocular complications associated with trauma
ETIOLOGY Blunt trauma leads to coup injury to the lens (Vossius ring on the anterior capsule), contrecoup injury (Rosette opacification of the posterior cortex), and axial expansion of the lens (Disruption of the anterior/posterior capsule and zonules)
Penetrating trauma leads to a localized cortical opacification in the area of the injury
Exposure to radiation and electrocution can also cause traumatic cataracts
DIFFERENTIAL DX Cortical cataract, Sutural cataract, Posterior subcapsular cataract, Anterior subcapsular cataract, Sunflower cataract
NOTES A traumatic cataract can show up immediately or a few months after the trauma
Traumatic cataracts can be stable or progressive