Perforation

A perforating wound of the eye bears a much higher risk of cataract formation. If the perforating object (e.g., a broken beer glass) passes through the cornea without touching the lens, the lens is usually spared and, in the absence of significant contusion, a cataract does not form. This, of course, also depends on careful management of the corneal wound and the prevention of infection. Unfortunately, such perforating injuries can also involve splitting of the lens capsule, with spilling out of the lens fibres into the anterior chamber. The series of events following such an injury is dependent on the age of the individual. When the lens capsule of a child is ruptured, a vigorous inflammatory reaction is set up in the anterior chamber and the lens matter will usually gradually become absorbed, in the absence of treatment, over a period of about a month. This leaves behind the lens capsule and often a clear pupil. In spite of this, the patient cannot see clearly because most of the refractive power of the eye is lost. This has serious optical consequences and the need for an artificial intraocular lens. When the lens capsule of an adult is ruptured, a similar inflammatory reaction ensues, but there tends to be more fibrosis, and a white plaque of fibrous tissue could remain to obstruct the pupil. Rarely, it is possible for a lens to be perforated with subsequent opacity limited to the site of perforation - indeed, one occasionally sees a foreign body within the lens surrounded by opaque fibres but limited to a small part of the lens.

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