Advertisement

Trauma to the Anterior Chamber and Lens

  • Neha Shaik
  • Jay Arora
  • Jewel Liao
  • Allison E. RizzutiEmail author
Chapter

Abstract

The anterior chamber and lens are commonly injured after blunt and penetrating trauma. Due to their anterior position in the skull, these structures are affected by both direct and indirect forces, leading to a variety of clinical findings. In this chapter we discuss the anatomy, as well as the etiology, presentation, management, and prognosis of injuries to the anterior chamber and lens. Hyphema, or blood in the anterior chamber, is a common sequela of blunt trauma to the eye. Its presence often indicates extensive intraocular tissue damage and its associated complications can lead to severe vision loss. Traumatic iritis, or anterior chamber inflammation following blunt trauma, is self-limited and benign. The iris is a thin tissue that lacks structural support, and is particularly susceptible to injury. Iris sphincter tears, iridodialysis, and aniridia are iris injuries that may be encountered. Injury to the crystalline lens is common, and can range from asymptomatic focal opacities to complete cataract formation with severe vision loss. The delicate zonular fibers that hold the lens in position, are easily disrupted following trauma, leading to lens subluxation or dislocation. Surgical management of traumatic lens injury is challenging as damage to the lens capsule and zonules may be found intraoperatively. We also discuss trauma to the pseudophakic eye, in which intraocular lens dislocation and wound dehiscence are possible occurrences after trauma.

Keywords

Hyphema Traumatic iritis Traumatic mydriasis Iridodialysis Cyclodialysis Anridia Traumatic cataract Zonular dehiscence Lens subluxation Dislocation Wound dehiscence 

References

  1. 1.
    Feng MT, Belin MW, Ambrosio R Jr, Grewal SP, Yan W, Shaheen MS, Steinmueller A. Anterior chamber depth in normal subjects by rotating scheimpflug imaging. Saudi J Ophthalmol. 2011;25(3):255–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Trattler WB, Kaiser PK, Friedman NJ. Chapter 10: anterior segment in review of ophthalmology. Edinburgh: Saunders Elsevier; 2012.Google Scholar
  3. 3.
    Hoskins HD. Secondary glaucoma. In: Heilman K, Richardson KT, editors. Glaucoma: conceptions of a disease, pathogenesis, diagnosis therapy. Philadelphia: WB Saunders; 1978. p. 376.Google Scholar
  4. 4.
    Read J, Goldberg MF. Comparison of medical treatment for traumatic hyphema. In: Transactions of the American Academy of Ophthalmology and Otolaryngology, vol. 78. 5 ed. 1974.Google Scholar
  5. 5.
    Walton W, Von Hagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol. 2002;47(4):297–334.CrossRefPubMedGoogle Scholar
  6. 6.
    Spoor TC, Kwitko GM, O’Grady JM, Ramocki JM. Traumatic hyphema in an urban population. Am J Ophthalmol. 1990;109(1):23–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Rahmani B, Jahadi HR, Rajaeefard A. An analysis of risk for secondary hemorrhage in traumatic hyphema. Ophthalmology. 1999;106(2):380–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Nasrullah A, Kerr NC. Sickle cell trait as a risk factor for secondary hemorrhage in children with traumatic hyphema. Am J Ophthalmol. 1997;123(6):783–90.CrossRefPubMedGoogle Scholar
  9. 9.
    Gharaibeh A, Savage HI, Scherer RW, Goldberg MF, Lindsley K. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev. 2013;12:Cd005431.Google Scholar
  10. 10.
    Crawford JS, Lewandowski RL, Chan W. The effect of aspirin on rebleeding in traumatic hyphema. Am J Ophthalmol. 1975;80(3 Pt 2):543–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Kutner B, Fourman S, Brein K, Hobson S, Mrvos D, Sheppard J, Weisman S. Aminocaproic acid reduces the risk of secondary hemorrhage in patients with traumatic hyphema. Arch Ophthalmol. 1987;105(2):206–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Pieramici DJ, Goldberg MF, Melia M, Fekrat S, Bradford CA, Faulkner A, Santander SH. A phase III, multicenter, randomized, placebo-controlled clinical trial of topical aminocaproic acid (Caprogel) in the management of traumatic hyphema. Ophthalmology. 2003;110(11):2106–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Crouch ER Jr, Williams PB, Gray MK, Crouch ER, Chames M. Topical aminocaproic acid in the treatment of traumatic hyphema. Arch Ophthalmol. 1997;115(9):1106–12.CrossRefPubMedGoogle Scholar
  14. 14.
    Read J. Traumatic hyphema: surgical vs medical management. Ann Ophthalmol. 1975;7(5):659–662, 664–656, 668-670.Google Scholar
  15. 15.
    Rosenbaum JT, Tammaro J, Robertson JE Jr. Uveitis precipitated by nonpenetrating ocular trauma. Am J Ophthalmol. 1991;112(4):392–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Reidy JJ. Section 08: External disease and cornea. In: Basic and clinical science course. San Francisco, CA: American Academy of Ophthalmology; 2015. p. 363.Google Scholar
  17. 17.
    Islam, N., & Pavesio, C. (2010). Uveitis (acute anterior). BMJ Clin Evid. 2010.Google Scholar
  18. 18.
    Dunne JA, Travers JP. Double-blind clinical trial of topical steroids in anterior uveitis. Br J Ophthalmol. 1979;63(11):762–7.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Dunn SP, Stec L. Chapter 8: Iris reconstruction. Ophthalmic microsurgical suturing techniques. Berlin: Springer; 2007. p. 71–83.Google Scholar
  20. 20.
    Ogawa GS. The iris cerclage suture for permanent mydriasis: a running suture technique. Ophthalmic Surg Lasers. 1998;29(12):1001–9.PubMedGoogle Scholar
  21. 21.
    Canavan YM, Archer DB. Anterior segment consequences of blunt ocular injury. Br J Ophthalmol. 1982;66(9):549–55.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ellong A, Ebana Mvogo C, Nyouma Moune E, Bella-Hiag A, Ngosso A, Njoh Litumbe C. Post-traumatic glaucoma with irido-corneal angle injuries in Cameroon. Bull Soc Belge Ophtalmol. 2005;(298):21–28.Google Scholar
  23. 23.
    Chang DF. Siepser slipknot for McCannel iris-suture fixation of subluxated intraocular lenses. J Cataract Refract Surg. 2004;30(6):1170–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Burk SE, Da Mata AP, Snyder ME, Cionni RJ, Cohen JS, Osher RH. Prosthetic iris implantation for congenital, traumatic, or functional iris deficiencies. J Cataract Refract Surg. 2001;27(11):1732–40.CrossRefPubMedGoogle Scholar
  25. 25.
    Navon SE. Expulsive iridodialysis: an isolated injury after phacoemulsification. J Cataract Refract Surg. 1997;23(5):805–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Ball J, Caesar R, Choudhuri D. Mystery of the vanishing Iris. J Cataract Refract Surg. 2002;28(1):180–1.CrossRefPubMedGoogle Scholar
  27. 27.
    Choyce P. Intra-ocular lenses and implants HK Lewis. London: England p; 1964. p. 27–32.Google Scholar
  28. 28.
    Ioannidis AS, Barton K. Cyclodialysis cleft: causes and repair. Curr Opin Ophthalmol. 2010;21(2):150–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Han JC, Kwun YK, Cho SH, Kee C. Long-term outcomes of argon laser photocoagulation in small size cyclodialysis cleft. BMC Ophthalmol. 2015;15:123.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Ioannidis AS, Bunce C, Barton K. The evaluation and surgical management of cyclodialysis clefts that have failed to respond to conservative management. Br J Ophthalmol. 2014;98(4):544–9.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Smith MP, Colyer MH, Weichel ED, Stutzman RD. Traumatic cataracts secondary to combat ocular trauma. J Cataract Refract Surg. 2015;41(8):1693–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Wolter JR. Coup-contrecoup mechanism of ocular injuries. Am J Ophthalmol. 1963;56:785–96.CrossRefPubMedGoogle Scholar
  33. 33.
    Weidenthal DT, Schepens CL. Peripheral fundus changes associated with ocular contusion. Am J Ophthalmol. 1966;62(3):465–77.CrossRefPubMedGoogle Scholar
  34. 34.
    Bruce M, Zagelbaum PS. Anterior segment truama. In: Miller JW, Albert DM, editors. Albert & Jakobiec’s principles & practice of ophthalmology. Philadelphia: Elsevier, 2008. p. 5093–5111.Google Scholar
  35. 35.
    Das Gupta BK, Basu RK. Bilateral dislocation of lens under complete voluntary control in Marfan’s syndrome with cardiovascular anomaly. Br J Ophthalmol. 1955;39(9):566–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Oh J, Smiddy WE. Pars plana lensectomy combined with pars plana vitrectomy for dislocated cataract. J Cataract Refract Surg. 2010;36(7):1189–94.CrossRefPubMedGoogle Scholar
  37. 37.
    Choi DY, Kim JG, Song BJ. Surgical management of crystalline lens dislocation into the anterior chamber with corneal touch and secondary glaucoma. J Cataract Refract Surg. 2004;30(3):718–21.CrossRefPubMedGoogle Scholar
  38. 38.
    Magli A, Iovine A, Bruzzese D, Giani U, Fimiani F. Strabismus in developmental cataract. Eur J Ophthalmol. 2008;18(4):540–3.PubMedGoogle Scholar
  39. 39.
    Rumelt S, Rehany U. The influence of surgery and intraocular lens implantation timing on visual outcome in traumatic cataract. Graefes Arch Clin Exp Ophthalmol. 2010;248(9):1293–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Blum M, Tetz MR, Greiner C, Voelcker HE. Treatment of traumatic cataracts. J Cataract Refract Surg. 1996;22(3):342–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Irvine JA, Smith RF. Lens injuries. In: Shingleton BJ, Hersh PS, Kenyon KR, editors. Eye trauma. St Louis: MO, Mosby; 1991. p. 126–35.Google Scholar
  42. 42.
    Menapace R, Findl O, Georgopoulos M, Rainer G, Vass C, Schmetterer K. The capsular tension ring: designs, applications, and techniques. J Cataract Refract Surg. 2000;26(6):898–912.CrossRefPubMedGoogle Scholar
  43. 43.
    Hoffman RS, Snyder ME, Devgan U, Allen QB, Yeoh R, Braga-Mele R. Management of the subluxated crystalline lens. J Cataract Refract Surg. 2013;39(12):1904–15.CrossRefPubMedGoogle Scholar
  44. 44.
    Shah MA, Shah SM, Shah SB, Patel CG, Patel UA, Appleware A, Gupta A. Comparative study of final visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract. Graefes Arch Clin Exp Ophthalmol. 2011;249(12):1775–81.CrossRefPubMedGoogle Scholar
  45. 45.
    Shah MA, Shah SM, Applewar A, Patel C, Shah S, Patel U. OcularTrauma score: a useful predictor of visual outcome at six weeks in patients with traumatic cataract. Ophthalmology. 2012;119(7):1336–41.CrossRefPubMedGoogle Scholar
  46. 46.
    Olsen TW, Pribila JT. Pars plana vitrectomy with endoscope-guided sutured posterior chamber intraocular lens implantation in children and adults. Am J Ophthalmol. 2001;151(2):287–296.e282.Google Scholar
  47. 47.
    Alzuhairy SA, Bosley TM, Alotaibi AG. Retrospective review of visual outcome in operated lens subluxation. Saudi Med J. 2013;34(10):1030–4.PubMedGoogle Scholar
  48. 48.
    Gul A, Duran M, Can E, Yucel OE, Sullu Y. Surgical management of intraocular lens dislocations. Arq Bras Oftalmol. 2015;78(5):313–7.CrossRefPubMedGoogle Scholar
  49. 49.
    Michaeli A, Soiberman U, Loewenstein A. Outcome of Iris fixation of subluxated intraocular lenses. Graefes Arch Clin Exp Ophthalmol. 2012;250(9):1327–32.CrossRefPubMedGoogle Scholar
  50. 50.
    Mello MO Jr, Scott IU, Smiddy WE, Flynn HW, Feuer W. Surgical management and outcomes of dislocated intraocular lenses. Ophthalmology. 2000;107(1):62–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Kim SS, Smiddy WE, Feuer W, Shi W. Management of dislocated intraocular lenses. Ophthalmology. 2008;115(10):1699–704.CrossRefPubMedGoogle Scholar
  52. 52.
    Jakobsson G, Zetterberg M, Sundelin K, Stenevi U. Surgical repositioning of intraocular lenses after late dislocation: complications, effect on intraocular pressure, and visual outcomes. J Cataract Refract Surg. 2013;39(12):1879–85.CrossRefPubMedGoogle Scholar
  53. 53.
    Gross JG, Kokame GT, Weinberg DV. In-the-bag intraocular lens dislocation. Am J Ophthalmol. 2004;137(4):630–5.PubMedGoogle Scholar
  54. 54.
    Kloek CE, Andreoli MT, Andreoli CM. Characteristics of traumatic cataract wound dehiscence. Am J Ophthalmol. 2011;152(2):229–33.CrossRefPubMedGoogle Scholar
  55. 55.
    Tseng SH, Lin SC, Chen FK. Traumatic wound dehiscence after penetrating keratoplasty: clinical features and outcome in 21 cases. Cornea. 1999;18(5):553–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Neha Shaik
    • 1
    • 2
  • Jay Arora
    • 1
    • 2
  • Jewel Liao
    • 1
    • 2
  • Allison E. Rizzuti
    • 1
    • 2
    Email author
  1. 1.Department of OphthalmologyThe State University of New York (SUNY) Downstate Medical CenterBrooklynUSA
  2. 2.Kings County Hospital CenterBrooklynUSA

Personalised recommendations