Traumatic cataract is cataract caused by direct damage to the crystalline lens following blunt injury, penetrating injury, or electrical/chemical trauma. It is commoner in young, working-age patients and children. Each traumatic cataract is a different eye with a different injury — which is why specialist evaluation and individualised planning are essential.

Mechanisms of Injury

Blunt trauma

Contusion (stick injury, cricket ball, firecracker blast, road traffic injury) can disrupt the lens zonules, cause subluxation or dislocation of the lens, and produce characteristic petal-shaped “rosette” opacities.

Penetrating trauma

A sharp object tearing through the cornea can rupture the anterior lens capsule. Lens material may swell and leak into the anterior chamber, causing raised pressure and severe inflammation.

Other mechanisms

• Electrical injury — snowflake, posterior subcapsular opacities
• Chemical injury — generally late cataract after severe alkali or acid burn
• Radiation and thermal injury

Initial Assessment

Our priority in any eye injury is first to rule out globe rupture and to manage associated injuries — corneal lacerations, iris damage, hyphaema, vitreous haemorrhage, retinal detachment. The cataract is only part of the picture. Key assessments include:

• Visual acuity and projection of light
• Full slit-lamp examination — corneal, anterior chamber, iris, pupil, lens position and capsule integrity
• Intraocular pressure measurement (with caution in possibly open globes)
• Dilated fundus examination where safe
• B-scan ultrasound when the view is obscured
• Orbital CT if an intra-ocular foreign body is suspected

Timing of Surgery

• Immediate — if the lens is ruptured, inflamed, or raising IOP
• Urgent (within days) — if lens matter is in the anterior chamber
• Planned (weeks) — if the eye is quiet and the capsule is stable. Waiting allows inflammation to settle and measurements to be more accurate.

Surgical Approach

Traumatic cataract surgery requires a surgeon experienced in dealing with unexpected findings — weak or absent zonular support, capsular tears, dropped lens fragments, iris damage and vitreous prolapse. Depending on the situation we may:

• Perform standard phacoemulsification with capsular tension ring and in-the-bag IOL
• Use a capsular hook system to stabilise weak zonules
• Implant a scleral-fixated IOL (sutured or sutureless / glued)
• Implant an iris-claw IOL (retropupillary or pre-pupillary fixation)
• Occasionally leave the eye aphakic with a contact lens correction
• Perform pars plana lensectomy with anterior vitrectomy in complex cases

Long-term Monitoring

Every traumatic eye needs long-term follow-up. Delayed complications include traumatic glaucoma (months to years later), retinal detachment, post-traumatic uveitis, and corneal decompensation. Children need particular attention for amblyopia prevention.