Inflammation after corneoscleral rupture and traumatic cataract due to blunt trauma in a child: a case report

Clara Verlina Suhardi,Graecia Bungaran,Nashrul Ihsan

doi:10.15562/ism.v12i2.1068

Abstract

Background: Ocular trauma is the most common cause of acquired monocular blindness in children. It is because of the inflammation following corneoscleral rupture and traumatic cataracts due to blunt trauma. This case study aims to evaluate the corneoscleral rupture and traumatic cataracts due to blunt trauma in a child.Case Presentation: We present a 5-year-old male who sustained blunt trauma to his right eye. He presented with blurry vision, mild pain and watering from the affected eye. His examination revealed visual acuity of 6/60 in the right eye (RE), corneal laceration extending from 3 o’clock towards 11 o’clock with possible extension to the sclera, and cortical lens matter in the anterior chamber. The patient underwent globe rupture repair under general anesthesia immediately. Postoperative day one revealed 2 mm hypopyon thick inflammation cells and fibrin. He was on topical steroids and topical antibiotics. The fourth postoperative day showed reduced inflammation, wound sutures in place and absence of hypopyon, thick membranous in the pupil. The patient is then referred to the Pediatric Ophthalmology department for a follow-up operation of clearing lens particle remnants to reduce inflammation and IOL insertion. Conclusion: Management of the injury and traumatic cataract is crucial to prevent vision loss and amblyopia, to maintain binocularity, prevent strabismus or even phthisis bulbi. Along with early management, routine follow-up examination for prevention of other unwanted complications is advised.

Highlights

Ocular trauma is the most common cause of acquired monocular blindness in children
Visual prognosis of Open Globe Injury (OGI) in children is worse than adults due to the severe nature of injuries, amblyopia, traumatic cataract, and infectious endophthalmitis due to delayed presentation.[2,3]
In a study conducted in India, about 41,2% of ocular trauma occurred in children 2 – 6 years old, with a 2.9:1 male to female ratio, and the most common cause of injury occurs during sport and recreational events.[10,11]

Summary

INTRODUCTION

Ocular trauma is the most common cause of acquired monocular blindness in children. Globally, around 3.3–5.7 million children under 15 years of age suffer from ocular trauma every year with pediatric ocular trauma being more prevalent in males.[1]. A previously healthy 5-year-old male child was admitted to the outpatient department after falling off his bike and his right eye hitting the handlebar one day prior to arrival He reported no loss of consciousness, nausea or vomiting after the incident. The posterior capsule lens ruptured due to trauma and vitreous contents were found in the COA, which hindered the cataract extraction process This initial operation was done solely to close globe rupture to maintain RE integrity and prevent further infection and unwanted complications. By the fourth postoperative day showed reduced inflammation, wound sutures in place, absence of hypopyon, but there was a thick membranous in the pupil, which possible inflammation inside the eye (Figure 3) In this follow-up period, The patient is referred to the Pediatric Ophthalmology department for a follow-up operation of clearing lens particle remnants that are still left to reduce inflammation and IOL insertion further

DISCUSSION

CONCLUSION