Anterior Lens Discolation After Blunt Trauma - Case Report

Blunt ocular trauma results in a sudden compressive deformation of the globe, displacing the cornea and the anterior sclera posteriorly with a compensatory expansion of the globe in the equatorial direction, which disrupts the zonular fibers and may dislocate de lens. We report a case of traumatic lens dislocation into the anterior chamber in a patient following blunt ocular injury.

Ophthalmology Emergency Department of Centro Hospitalar de Leiria, in Leiria, Portugal.

A 56-year-old male presented to the ophthalmology emergency department with a painful vision loss of the right eye (OD) after ocular blunt trauma. His OD visual acuity (VA) was 50 centimetres finger count and the intraocular pressure (IOP) was 56 mmHg. The biomicroscopy presented anterior lens dislocation. Secondary acute angle-closure glaucoma, with pupillary block due to anterior dislocation of the lens, was diagnosed. He was promptly treated with mannitol and hypotensive agents and were performed three iridotomies. The pupillary block was reversed and a IOP of 23mmHg was reached. Two days after the incident the pacient underwent intracapsular cataract extraction and anterior vitrectomy. No intraocular lens (IOL) was placed at that time. Four weeks after surgery there was favourable recovery, with a non corrected VA of 0.5/10, IOP of 17mmHg and the biomicroscopy revealed a superior corneoscleral suture, traumatic midriasis and aphakia. One week later the pacient experienced mild pain that lead him to the emergency once again. Examination of the anterior chamber showed conjunctival hiperemia and a superior iris encarceration it the corneoscleral suture zone. A second surgery was performed for iris reposition and secondary anterior chamber IOL implantation. At two months’ follow-up visit, the best corrected VA of the right eye was 8/10 and IOP was 17mmHg.

Although traumatic lens dislocation is a relatively uncommon sequel of blunt ocular injury, prompt recognition of this problem facilitates visual rehabilitation and may avoid development of vision-threatening glaucoma. The patient we present in this report was treated successfully with intracapsular extraction and anterior vitrectomy. The prognosis for patients with traumatic dislocation of the lens is good with prompt recognition of this type of injury and treatment of glaucoma. The outcome may be poor if prolonged anterior lens dislocation results in corneal decompensation, or if glaucoma associated with lens dislocation is not promptly recognized and treated.