This article is more than 5 years old. Information may no longer be current.
The lens is where?
Click Here to Manage Email Alerts
 Crystalline lens in the anterior chamber after trauma. |
A 52-year-old patient was in a car accident in which the airbags deployed and hit him in the face. The ER is calling you because the vision of his left eye is hand motions only, and his crystalline lens is in the anterior chamber.
Examination shows that his crystalline lens is completely in the anterior chamber with central lens-cornea touch, corneal edema and an inflamed anterior segment. IOP is 28 mm Hg. The right eye exam is completely normal with 20/20 vision, a pressure of 19 mm Hg, and a normal anterior and posterior exam. There is no afferent pupillary defect noted, and a B-scan of the posterior segment of the left eye shows an attached retina and clear vitreous. The rest of the eye/orbital exam is normal, and the patient has been cleared systemically by the ER doctor.
There are two schools of thought with regards to treating this patient: (1) treat medically first or (2) treat surgically first. In this situation, we elected to treat the eye medically first: Dilate the pupil and try to get the lens to go back into the posterior chamber, and give topical steroids to treat the inflammation and topical medications to reduce the IOP. Surgery can always be done at a later date. The primary concern is protecting the corneal endothelium and getting the crystalline lens away from it. The crystalline lens will be removed and replaced with an IOL at some point in the future, but we'd like to avoid the need for corneal endothelial transplantation.
What would be your approach to this patient?
See Dr. Devgan share more expert insight live at Hawaiian Eye 2012, to be held January 15-20, 2012 at the Grand Wailea Resort & Spa in Wailea, Maui. Learn more at OSNHawaiianEye.com.