p < 0.0001

© Fig. 2.7.1 Trauma-related lens pathologies. The lesions can occur alone or in combination.

a This term is used in some literature reports to describe luxation, as opposed to subluxation, of the lens.

b May be accompanied by lens swelling. Intralenticular FBs are discussed in Chap. 2.13

Fig. 2.7.2 Lens subluxation with iridodialysis. The lens is dislocated toward 10 o'clock; the iris is torn from its root between 2 and 11 o'clock. Red reflex is visible through the pupil as well as in the area of the iridodialysis. The edge of the lens is easily discernible

on retroillumination if the pupil is wide (Fig. 2.7.2). Typically, the lens and the iris show characteristic oscillatory movements when the eye or head moves (phacodonesis and iridodonesis, respectively). Depending on the site and area of zonular damage, the symptom may be present when the patient is in the erect but not in the supine position [10]. Vitreous prolapse is common: in the HEIR database, 34% of eyes with lens trauma showed vitreous prolapse into the AC.

The ophthalmoscope can supplant information if the lens is luxated into the vitreous. Ultrasonography may help to identify lens dislocation, posterior capsular rupture, or the presence of lens particles in the vitreous cavity. The CT is able to reveal lens damage even if the clinical examination is negative [4]. As always, injuries to any and all tissues of the eye must be suspected and sought.

It is important to realize that the preoperative and intraoperative findings may be quite different (Table 2.7.3); this has a major impact on surgical planning (see Chap. 1.8). As mentioned previously, intracamerally injected TA is able to show the presence and configuration of vitreous in the AC;

Table 2.7.3 Comparison of pre- and intraoperative findings (%) among 196 eyes undergoing extraction of a traumatic cataract


Breach presence

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