Traumatic Cataract: 11 year-old boy with glass injury to the right eye


CC:
11 year-old male seen for evaluation of an open globe and traumatic cataract.
HPI:
An 11 year-old male was referred to the University of Iowa Hospitals and Clinics for evaluation of a possible open globe. One day prior, while hammering on a taillight of an old automobile a glass shard flew into his right eye. The boy complained of pain and a foreign body sensation and was taken to the local emergency treatment center for evaluation. A slit lamp examination failed to reveal a foreign body. Early the next morning he awoke with worsening pain and decreased vision. A local ophthalmologist noted a corneal laceration and cataract, but could not rule out the presence of an intraocular foreign body and referred him to the UIHC.

Upon arrival, he continued to complain of pain and decreased vision in his right eye
.
Past Ocular History:
No prior ocular injury, surgery, or illness.
Past Medical History: Non-contributory

Medications:
Gatifloxacin (Zymar) ophthalmic drops, 4x/day, in the right eye.
Family and Social History:

Noncontributory
Exam, Ocular:
•Visual Acuity, without correction: right eye (OD)--20/70; left eye (OS)--20/20
•Motility: Normal; no restrictions
•Confrontation visual fields: Full, both eyes (OU)
•Intra-ocular pressure: OD -- 15; OS not attempted due to risk of open globe
•Pupils: No relative afferent pupillary defect (RAPD)
•Slit lamp examination, OD: (see Figure 1)
◦2.5 mm diameter full- thickness stellate corneal laceration (Seidel negative)
◦Anterior chamber - deep with 1+ cell and flare
◦Anterior capsular tear - from 11:00 to 4:00 position and extending to the zonules
◦Cortical lens material protruding through the tear
•Dilated fundus exam (DFE): Noforeign body. No vitreous hemorrhage or vitritis. Normal macula, vessels, and periphery, OU
Other examination:
No IOFB detected by maxillofacial CT or ocular echography. The posterior lens capsule appeared to be intact with b-scan echography.
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