A cataract is an abnormal clouding of the masses of the lens of the eye, which causes a significant deterioration in visual acuity. As a rule, the disease develops in older people, although it cannot be guaranteed that a young person will not have cataracts. There are many causes of cataracts. Traumatic cataracts can occur immediately after a blow or many years later, so even old injuries must be taken into account when diagnosing the disease.

The role of the lens in the visual system

Lens human eye is a transparent natural lens that acts as part of an optical apparatus. It is located behind the pupil and iris. It is noteworthy that the lens does not contain blood vessels or nerves, but is “nourished” through the intraocular fluid in which it is immersed.

Without the lens, light impulses cannot be transmitted and light cannot be refracted. This element of the eye provides accommodation (adjustment). It is the lens that divides the eyeball into anterior and posterior sections. He is protection vitreous from microbes when inflammation of the anterior chamber of the eye develops.

The lens is a very sensitive element eyeball. Under sudden influence and in poor conditions, dangerous processes begin in it. Even with a mild injury, the lens may begin to become cloudy and stop performing its functions.

Cloudiness of the lens is called a cataract. This condition is characterized by a gradual decrease in vision, difficulty determining the boundaries of objects, and the inability to distinguish objects in poor lighting. Patients with cataracts note that they have to look at the world as if through foggy glass.

Types of traumatic cataracts and their symptoms

Traumatic cataracts can be partial or complete (local and total). There are also semi-resolved cataracts and dense ones.

Types of cataracts according to the position of the lens:

membranous (normal position);
subluxation (partial shift);
luxation (complete shift to the fundus).

Types of cataracts by type of injury:

contusion (blunt eye injuries);
toric (damage from chemicals);
wound (penetrating injuries);
radiation (damage from ionizing radiation).

Symptoms of traumatic cataracts will depend on the location of the opacities. If there is a posterior subcapsular cataract, symptoms are usually severe and extensive. Cortical and sclerotic opacities add less discomfort to the patient.

The most common type of cataract is contusion cataract. Damage can occur with direct concussion, that is, with a blow with a blunt object, and indirect (to the head). The cause of toxic cataracts is all kinds of burns of the eyeballs with aggressive liquids. In addition, clouding can develop in case of severe poisoning with ergot, nitro dyes, trinitrotoluene and other substances.

Radiation opacities are predominantly ring-shaped. With radiation cataracts, colored spots are visible on the gray background of the lens. This feature is used for differential diagnosis.

Modern medicine only offers surgical methods treatment of traumatic cataracts. Such eye injuries, which can cause clouding, often end badly because they damage the structures of the posterior segment of the eye. Patients often develop retinal detachment, macular fibrosis, and optic neuropathy. Sometimes afferent pupillary failure and iridodialysis are also detected.

How does traumatic cataract develop?

At closed injury eye cataracts develop in 11% of cases. During injury, the eyeball is subject to impact and counter-impact forces. A strike is a direct force, and a counterstrike is a reflected force. It is the counterblow that damages the lens more strongly. When subjected to mechanical action, the eyeball shortens, the lens capsule ruptures, and the ligaments of zonules are torn off. And everything happens at the same time. The more precise mechanism of damage to the lens capsule during trauma is not clear.

The capsule is able to quickly regenerate (properties of subcapsular epithelium), so damage up to 2 mm is quickly restored. If damage exceeds 3 mm, opacification occurs: rupture of the capsule leads to intraocular fluid enters the lens.

Capsular injuries may suddenly open days or months after the injury. In this case, secondary glaucoma, severe inflammation and cataracts often develop. And although most often traumatic cataracts are not associated with damage to the capsule, this factor cannot be excluded.

In most cases, traumatic cataract occurs due to the fact that at the time of contusion, subcapsular opacities are formed in the cortical layers of the lens. Such opacities have the shape of petals and spokes, diverging radially.

Without treatment, traumatic cataracts can progress to the point that fundus examination becomes difficult. As cataracts mature, vision decreases, intraocular pressure increases, and inflammation recurs.

Diagnosis of cataracts and preoperative examination

You need to schedule a visit to the doctor if you notice deterioration in vision and loss of clarity. Only comprehensive diagnostics using special equipment can identify the causes of the violation.

Examination for cataracts includes the following measures:

visual acuity test();
determination of the degree of refraction of the eyes, measurement of the curvature and refractive power of the cornea (computer keratorefractometry);
study of the anterior segment of the eye, assessment of the condition of the lens and iris (biomicroscopy);
checking the angle of the anterior chamber (gonioscopy);
determination of visual fields (perimetry);
checking the level (tonometry);
condition assessment optic nerve and retina (ophthalmoscopy);
measurement of the thickness of the cornea and lens, the depth of the anterior chamber, assessment of the condition of the vitreous body and retina (ultrasound scanning);
comprehensive study of the anterior segment, detailed examination of the cornea ().

Since cataracts are often treated with the installation of intraocular lenses, during the diagnostic process it is necessary to study the condition of the cornea in detail. The radius of curvature of this shell allows us to calculate the necessary lens parameters. If a traumatic cataract is suspected, it is important to perform a B-mode ultrasound scan. This allows you to find breaks and timely determine the presence of retinal or choroidal detachment.

Before the operation, you should undergo a thorough examination, if necessary, visit other specialists and make sure there are no contraindications. The purpose of ophthalmological diagnosis is to detect or exclude phacodonesis and vitreous hernia, and examine the posterior capsule. Before surgery, it is important to check the condition of the ligaments of Zinn.

Surgical treatment of traumatic cataracts

The timing of opacification removal will depend on the severity of the inflammatory process, the need to restore vision (this applies to children with an increased risk of amblyopia), future operations and general condition sick. The treatment method and timing should be determined by the doctor, taking into account the vision prognosis and the presence of accompanying pathologies. The surgical plan will be based on the severity and location of the cataract.

The most common method is considered, but surgery is contraindicated for brown cataracts. The lens is removed using ultrasound through a small puncture. The entire procedure takes up to 20 minutes. The doctor breaks up the cloudy masses and sucks them out of the capsule in order to insert a special lens into the vacant space. Modern implants are no different in functionality from a natural lens. The rehabilitation period does not take much time, and postoperative recommendations do not complicate the patient’s life. In the vast majority of cases, the operation provides complete cure from cataracts.

Sometimes they resort to extracapsular extraction. This method is used less and less, although it remains acceptable if the ligaments of Zinn are weak and there is no vitreous hernia. Technologies that make it possible to implant intracapsular rings and capsular hooks are used when removing traumatic cataracts using an anterior approach. In the presence of severe phacodonesis, lens subluxation and capsule damage, another method of removing the opacities should be considered.

Primary extraction of traumatic cataracts is advantageous in that it eliminates the cause of inflammation, normalizes the level of intraocular pressure and carries out visual rehabilitation. Among the disadvantages of the procedure are the long period of rehabilitation and increased risk inflammation. It may also be that cataracts did not affect visual function, and surgery will not help restore it.

Implantation of an intraocular lens

Implantation of an intraocular lens can be carried out after cataract removal by any method (provided that there is no inflammation and the risk of infection is low). The lens can be installed in the capsular bag, anterior chamber, ciliary groove, and fixed near the sclera or iris.

In children, clouding of the lens greatly increases the chances of developing amblyopia (lazy eye syndrome). Since rapid opacification of the posterior capsule often occurs after extraction, capsulotomy and vitrectomy (anterior) must be performed along with it. When operating on a child, the doctor must minimize the impact on the developing eye.

Opacities do not always progress, so the doctor must determine the advisability of surgery. If other structures of the eye have not been damaged, unnecessary intervention can only cause harm. When cataracts do not impair vision or provoke inflammation, infection or glaucoma, dynamic monitoring of the condition of the lens is recommended.

Traumatic cataracts are not always treated surgically. In cases where the clouding is not localized in the center of the lens and is not very dense, optical correction can be done. This is due to the fact that such cataracts do not interfere with normal vision.

Traditional methods of treating cataracts

It must be remembered that no remedy can completely cure lens opacity. Traditional medicine in the treatment of cataracts can only be considered as complementary therapy which will stop the progression of the disease.

There are many recipes with honey. You can prepare drops based on it: dilute liquid honey with an antiseptic (20% sodium sulfate solution). This treatment is effective after 3-4 weeks of three daily instillations.

Before using any products, you should consult a doctor, but most often ophthalmologists do not recommend self-medication for cataracts due to its absolute ineffectiveness. Cloudiness from the eye can only be removed surgically, but it is not for nothing that it is effective conservative treatment Cataracts do not exist.

Drops for cataracts

The modern pharmaceutical market offers hundreds of drugs for a variety of pathologies visual system, and cataracts were no exception. Usually doctors prescribe drops only to relieve symptoms, since there is not enough on the market effective remedy for resorption of opacities.

For cataracts, Vitafacol, Quinax, Vitaiodurol, Taufon and are often prescribed. However replacement therapy(drugs containing substances, the deficiency of which is believed to cause cataracts) is ineffective for the traumatic nature of opacities. The eye may be completely healthy before the injury and not need additional “nutrition.”

Notably, most cataract drugs are not independently tested. The manufacturer himself organizes an effectiveness study, the results of which are not always reliable. Therefore, the effectiveness of numerous drugs for cataracts has not been scientifically proven, and therefore their use may be inappropriate.

Separately, it is worth mentioning Quinax drops. Only this drug has shown real, albeit insignificant, effectiveness in the treatment of senile, diabetic and other forms of cataracts. This drug is unique in its kind: it active substances are able to activate enzymes in the intraocular fluid and enhance the process of resorption of lens proteins. To achieve results, you need to use drops for years, which is unacceptable if the disease progresses rapidly.

Cataract drops can only be effective on initial stage development of the disease. Existing dense opacities can be completely cured only with surgery, so you should not postpone surgical treatment.

Prevention of cataracts

If in the case of age-related opacification it is almost impossible to avoid it, then it is possible to delay damage to the lens. The only measure to prevent traumatic cataracts is protection from damage.

To strengthen the visual system, you need to follow the rules and regulations healthy image life. Smoking and alcohol abuse are the main irritants of the whole body, so you need to give up bad habits.

You can increase the body's protective functions with the help of physical exercise, weight control, prevention nervous disorders. It cannot be said that these measures protect against cataracts, but failure to comply with them often contributes to the disease.

Special prevention of traumatic cataracts:

protection of the visual system from ultraviolet and microwave radiation;
adequate intake of drugs that increase tissue photosensitivity (steroids, antiallergic drugs, antidepressants, tranquilizers, contraceptives);
dosed consumption of coffee and products containing it;
glucose control and correct treatment diabetes mellitus

It must be remembered that eye drops They do not help get rid of the disease, they only stop its progression. You can even say that a clouded lens can no longer be saved, only replaced with an intraocular lens.

Hello again, dear readers! Surely you know that the lens is an incredibly fragile element of the visual system. Even the most minor injury can lead to changes as a result of which the lens substance begins to gradually become cloudy, leading to decreased vision.

Traumatic cataract is considered one of the most dangerous ophthalmological diseases associated with damage to the lens.

Its development can be provoked by penetrating wounds of the natural “lens”, contusion of the eyeball, negative impact chemical substances, high temperatures etc. In case of absence timely treatment irreversible loss of vision occurs.

When the integrity of the lens is compromised, it immediately becomes cloudy, gradually covering everything most natural "lens". There are cases when the lens substance swells instantly, which leads to a rapid increase in pressure inside the eye.

The development of traumatic cataracts can continue for several months or years after injury to the natural “lens”. As a rule, this occurs in cases where the damage to the lens is indirect.

What are the signs of traumatic cataract?

To detect a traumatic cataract, it is not necessary to contact an ophthalmologist, since it is often visible to the naked eye: the pupil begins to slowly fade - it becomes whitish. This happens almost immediately after damage to the lens.

If a person is not sure about the presence of the disease, he should pay attention to the following symptoms:

decreased clarity of vision;
the appearance of fog in the eye;
increased sensitivity to bright light sources;
the appearance of flashes in the eyes in the dark;
progressive development;
deterioration of color perception;
the need for more frequent replacement of diopters when ordering corrective optics;
double vision when closing one eye.

Is it possible to cure cataracts without surgery, read.

Diagnosis and treatment of the disease

When a person injures the organ of vision in any way, he should immediately seek help from a qualified specialist who will examine the fundus of the eye and, if necessary, perform biomicroscopy of the eye using slit lamp.

Only after a complete diagnosis and establishment of an accurate diagnosis will it be possible to begin treatment of the disease.

The timing and method of eliminating traumatic cataracts depend on the general condition of the patient (taking into account age and medical history), the presence of concomitant pathologies, and also on how severe the cataract is. inflammatory process, and in which part of the lens the clouding is localized.

Important! The most popular method of removing a pathological natural “lens” is considered ultrasonic phacoemulsification– an operation during which the damaged lens is removed under the influence of ultrasound through a microsurgical incision.

First, the clouded masses are crushed, after which the surgeon removes them from the capsule with a special device, and in the vacant space installs an artificial intraocular lens, which, in its own way, functional features similar to a natural lens.

Read about the features of cataract surgery.

Thanks to this operation, it is possible to completely get rid of any type of cataract. Its main advantages include:

painlessness;
no need for stitches;
quick recovery after surgery;
stability of results.

Treatment of traumatic cataracts is also carried out by performing extracapsular extraction. Although this method not as popular and widespread as the previous one, with its help it is possible to eliminate the damaged lens using an anterior approach.

The essence of the operation is to remove the nucleus and masses of the natural “lens”, while the posterior lens capsule remains intact. Unlike phacoemulsification, extracapsular cataract extraction has significant disadvantages, the main of which are:

the need for stitches;
high morbidity and blood loss;
long rehabilitation period.

conclusions

Friends, surgery to remove the clouded lens and subsequent IOL implantation is the only effective way treatment of traumatic cataracts, which provides consistently high results and significantly reduces the recovery time for patients after surgery.

The right ophthalmology clinic with qualified staff and modern equipment will allow you to get rid of cataracts and regain lost vision. See you again!

Share your stories on the topic of the article in the comments!

Sincerely, Olga Morozova.

Based on materials from the Great Patriotic War, uncomplicated course after penetrating wounds was observed in only 33.3%. In the remaining 66.7% there were complications, of which the most common was traumatic iridocyclitis.

If penetrating wound in the cornea or sclera It is small in size and glues quickly, if there is no loss inner shells and the environment of the eye, the wound process can proceed very calmly, without pain and without signs of eye irritation. It may result in cure with preservation of good vision.

Sometimes it's like this eye injury, received in a combat situation, remains unnoticed either by the wounded person himself or by the doctors treating him for concomitant injuries to other organs (for example, with multiple wounds from mine or grenade fragments). Such patients sometimes learn about a former eye injury only much later, during an examination of the eye by an ophthalmologist, performed for another reason. A retrospective diagnosis in these cases is made after detection of a through scar in the cornea, determined using a magnifying glass or visible in a narrow beam of light from a slit lamp. In other cases, signs of a former perforated wound of the sclera are unexpectedly discovered in the fundus. In this case, shadows can be found on radiographs foreign body in the eye many months and even years after injury. However, in most cases, sooner or later, the presence of a foreign body in the eye causes an outbreak of iridocyclitis, which brings such a patient to an ophthalmologist.

Damage to the lens in case of gunshot penetrating and through wounds of the eye, in many cases it significantly aggravates the course wound process. With any damage to the lens bag, aqueous humor penetrates the lens substance and causes clouding, swelling and disintegration of the lens fibers.

If wound hole in the capsule of the lens is very small in size and if it is immediately covered by the tissue of the iris fused with it, the clouding of the lens may be partial (only at the site of damage). Such damage to the lens does not have a noticeable effect on the course of the wound process. In the future, the clouding may not progress, or gradually the entire lens becomes cloudy (over many months, up to a year or more).

A different picture occurs for more significant ruptures of the lens bag, especially in the pupillary area, not covered by iris tissue. In these cases, clouding and swelling of the lens substance can progress rapidly. The lens masses extend into the anterior chamber and often fall out into the wound opening. Removing them instantly surgical treatment wounds promotes good healing. However, if a significant part of the damaged lens remains not removed, the lens masses continue to swell and can cause an increase in intraocular pressure in the following days. It is not always possible to normalize it with the help of miotics, intravenous injections of hypertonic (10%) solution sodium chloride and other conservative treatment methods. A picture of an acute attack of secondary glaucoma may develop, and therefore an urgent operation to release the swollen lens masses through a limbal incision made with a spear-shaped knife becomes necessary.

Lens masses can, in addition to increasing intraocular pressure, cause other reactive changes that significantly complicate the course of the wound process. Large particles of the lens can mechanically irritate the receptor-rich tissues of the iris and ciliary body. Even more important is that the breakdown products of the lens substance often act as a chemical irritant to the receptors, causing the development of an inflammatory reaction in the eye. In some cases, it can be detected using an intradermal test. increased sensitivity skin to lens protein (antigen). This served as the basis for calling the process in the eye “phacoanaphylactic endophthalmitis” (Verhoef and Lemoyne, M. G. Rabinovich, L. V. Pritsker, Hake, etc.). Some authors (Straub, K. X. Orlov, E. F. Levkoeva, etc.) consider the cause of the inflammatory reaction in the eye toxic effect substances of the lens and products of its disintegration into the tissue of the iris and ciliary body (“phacogenetic” or “phacotoxic” endophthalmitis).

By clinical picture difficult to differentiate phacoanaphylactic endophthalmitis from phacotoxic. Irvine, as well as K.I. Golubeva, believe that such differentiation is possible with pathological and histological examination of enucleated eyes.

According to E. F. Levkoeva and K.I. Golubeva, the toxic effect of lens masses leads to the formation of an infiltrate consisting of mononuclear cells with an admixture of polynuclear cells and having a strictly defined localization: it resembles an abscess, is found only in the damaged lens and does not spread to the intraocular membranes. In contrast, with phacoanaphylactic iridocyclitis, infiltration in the lens itself is almost absent (K.I. Golubeva) and is found only in areas of the iris that are in close contact with the damaged lens.

Verhoef, as well as Irvine, describe the morphological features differently phacoanaphylactic. Apparently, this issue needs further study.

The most important thing to note is that morphological changes both with phacoanaphylactic and phacotoxic processes in the eye are localized mainly in the anterior part of the eyeball. This makes it possible to distinguish them from sympathetic inflammation, which is most characterized by changes in the posterior part of the vascular tract of the eye.

For clinical purposes, it seems to us that the most appropriate term is “ phacogenic ophthalmia" It covers all cases of inflammation caused by particles of the lens or its decay products entering the eye cavity. Other terms (“phacoanaphylactic” and “phacotoxic” ophthalmia) can be reserved for those cases when it is possible to clarify, using an intradermal test, whether the nature of the inflammation is allergic or toxic.

In most cases traumatic cataract does not cause severe inflammation in the eye. Subsequently, the lens masses are partially resorbed in aqueous humor, absorbed and destroyed by macrophages. Complete resorption is rare. More often, there is the formation in the area of the pupil of connective tissue cords fused with the iris, which may contain remnants of the lens substance and the lens bag.

If the ones rolled in anterior chamber lens masses cause and maintain a severe course of “phacogenic ophthalmia”, it is necessary to perform an operation to remove them from the eye as soon as possible. It is recommended to end this intervention by thoroughly washing the anterior chamber with a solution of penicillin (2-5 thousand units in 1 ml), which helps remove the remnants of the lens masses not only from the anterior chamber, but also from the posterior chamber and at the same time is a means of preventing intraocular infection.

A different attitude to the issue of operations with traumatic cataracts it should be in cases where the lens bag sticks together early, intraocular pressure does not increase, and the inflammatory process in the eye either does not develop or proceeds relatively calmly and subsides with complex (conservative) treatment. In these cases, one should not rush into the operation of extracting a traumatic cataract in the army and front-line areas. It is recommended to wait until all signs of traumatic iridocyclitis are eliminated. Too early surgery can cause severe exacerbation of the inflammatory process.

It should be noted that instillation of cortisone emulsion into the eye every 2-3 hours (along with the use of atropine and other conservative treatment agents) in some cases quickly reduces the inflammatory reaction of the eye in phacogenic ophthalmia. Thanks to this, it is sometimes possible to delay the operation and perform it under more favorable conditions (on the non-irritated eye). The use of cortisone or adrenocorticotropic hormone is also indicated in postoperative period if there are signs of iridocyclitis.

Traumatic cataract usually due to mechanical damage lens, as a result of which intraocular fluid penetrated into the lens capsule.

As a rule, damage to the lens is accompanied by damage to other structures of the eye - the cornea, iris, etc., so surgical treatment includes manipulations not only on the lens, but also on neighboring structures of the eye. Traumatic cataracts also include lens opacities caused by burns eyes and exposure to ionizing radiation.

Symptoms

At the site of the injury, clouding occurs, gradually spreading to the entire lens. With minor damage to the capsule, sometimes the defect closes and a small local area of turbidity forms.

Cataracts often result from blunt trauma to the eye and lens. It is called contusion cataract. As a result of contusion, clouding initially occurs in the center of the lens, then it spreads to the posterior capsule, and then to the entire lens. However, most often the clouding affects only part of the lens. Sometimes, with a large impact force, the lens capsule can rupture completely, in which case the clouding after the injury covers the entire lens

Diagnostics

If the integrity of the lens is damaged, cataracts are detected immediately after the injury. Very rapid swelling of the lens substance is possible, causing a sharp increase in intraocular pressure and the development or exacerbation of anterior uveitis. Only sometimes cataracts do not progress, being limited to the initial clouding for a long time or forever. In the case where there is no direct damage to the lens, cataracts often do not develop immediately, but after a certain, sometimes distant (up to several months and years after injury or irradiation) period; ripens slowly.

Treatment

Treatment - . In case of rapid swelling of a traumatic cataract or, on the contrary, a long development of opacification, as well as depending on other factors (for example, the presence of a traumatic cataract in the better seeing eye) surgical intervention not postponed.

Damage to the lens of a traumatic nature is usually divided into several types: cataract, subluxation or dislocation. The causes of lens injury, as a rule, are direct penetrating wounds, closed injuries (contusions), impact electric shock, as well as ionizing radiation.

Trauma is the most common reason unilateral cataracts in young and middle-aged people.

Signs of traumatic damage to the lens

Small ruptures of the capsular bag of the lens are often well tolerated and lead to small segmental opacities that do not have a significant effect on vision. If the development of cataracts occurs weeks and months after the injury, then it can cause severe visual defects. Modern technologies cataract removal is highly effective and gives exceptional results, in the absence of damage to the cornea, macular spot(macula) and optic nerve.

If the operated eye is damaged in patients who have previously undergone cataract surgery with intraocular lens implantation, there is a risk of dislocation of the lens.

The lens is located behind the iris, attached to the fibers of the ciliary girdle, extending from the ciliary body. With a closed eye injury, the fibers of the girdle are often torn, which leads to partial dislocation (subluxation) or complete dislocation of the lens.

Diagnostics

When the lens is displaced (subluxated), its edge may be visible after the pupil dilates, while with complete dislocation, the lens can be dislocated into the anterior chamber or back onto the retina.

Signs of divergence of the fibers of the girdle are clearly visible in the light of a slit lamp and look like flickering of the iris during rapid movements of the eye. This condition is called iridodonesis. The diagnosis is made after an extensive examination under a slit lamp, or after detection of relevant signs during a computed tomography scan.

Treatment

Mild subluxation of the lens does not cause visual impairment, whereas in the case of more severe subluxations and posterior dislocations, spectacle correction is often required.

Need for surgical treatment occurs only in cases where the lens is dislocated anteriorly with damage to the corneal endothelium or blockage of the outflow of aqueous humor through the pupil. This condition leads to an acute attack of angle-closure glaucoma. Direct significant damage to the lens, resulting in inflammation of the eye, damage to the corneal endothelium, or increased intraocular pressure, in most cases requires lens extraction. The procedure can be performed primary or secondary, depending on the severity of the injury, the surgeon's choice (visibility), as well as other dependent factors.

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