SHORT COMMUNICATION
ARCH SOC ESP OFTALMOL 2007; 82: 641-644
OCULAR RUPTURE ASSOCIATED WITH LENS
DISLOCATION TO THE SUBCONJUNCTIVAL SPACE
ESTALLIDO OCULAR CON LUXACIÓN DE CRISTALINO AL
ESPACIO SUBCONJUNTIVAL
SANTOS-BUESO E1, SAENZ-FRANCÉS F2, DÍAZ-VALLE D1, TROYANO J2, LÓPEZ-ABAD C1,
BENÍTEZ-DEL-CASTILLO JM1, GARCÍA-SÁNCHEZ J1
ABSTRACT
RESUMEN
Case report: We present the case of a patient who
suffered from rupture of her left eye due to moderate blunt trauma. The lens, which was dislocated to
the nasal and superior subconjunctival space, was
extracted and the wound explored and repaired;
when the process had stabilized secondary vitrectomy and suture of an IOL to the sulcus were performed, achieving a final visual acuity of 0.3.
Discussion: Eye trauma is common and eye rupture may occur in those patients who have undergone
ocular surgery or suffer from a debilitating condition of the eye. None of these predisposing factors
existed in our case. Despite the seriousness of the
problem, appropriate treatment achieved good
visual function (Arch Soc Esp Oftalmol 2007; 82:
641-644).
Caso clínico: Se describe el caso de una paciente
que sufre estallido del globo ocular izquierdo
secundario a un traumatismo de moderada intensidad. Se produjo luxación del cristalino al espacio
subconjuntival nasal superior. El cristalino fue
extraído y al producirse la estabilidad del cuadro se
realizó vitrectomía y sutura de lente intraocular a
sulcus, alcanzando una agudeza visual de 0,3.
Discusión: Los traumatismos oculares son muy frecuentes y el estallido ocular suele producirse en
aquellos casos que presentan patología debilitante
del globo ocular o antecedentes de cirugías previas,
hechos que no se presentaban en nuestro caso. A
pesar de la gravedad del cuadro, la paciente alcanzó
una buena función visual final.
Key words: Trauma, dislocation, lens, subconjunctival space.
Palabras clave: Traumatismo, luxación, cristalino,
espacio subconjuntival.
Received: 13/9/06. Accepted: 20/9/07.
Ocular surface and inflammation unit. San Carlos Clinical Hospital. Madrid. Spain.
1 Ph.D. in Medicine.
2 Graduate in Medicine.
Awarded the best 2006 communication in the Madrid Ophthalmological Society.
Correspondence:
Enrique Santos Bueso
Servicio de Oftalmología. Hospital Clínico San Carlos
Avda. Prof. Martín Lagos, s/n
28040 Madrid
Spain
E-mail: esbueso@hotmail.com
SANTOS-BUESO E, et al.
INTRODUCTION
Ocular rupture with lens dislocation is a rare condition resulting from high-power traumas such as
car accidents or aggressions. The eye globe tends to
behave as a sphere difficult to comprehend when
involved in a traumatic impact, which absorbs the
energy transmitted by decreasing the anteroposterior diameter and expanding the equatorial plane.
Although impacts are absorbed by the eye globe,
rupture may occur where the impact took place
(direct rupture) or at a certain distance (indirect rupture) (1,2).
Impact tends to occur in the inferior temporal
sector of the eye globe, since it is left unprotected
by the orbit´s bone structure. Energy is projected
towards the superior nasal region; the globe collides
with the trochlea and the orbital wall. Ocular ruptures usually take place in this sector (2-4).
conjunctiva with intense and generalized chemosis,
full and transparent cornea and 100 percent hyphema hindering assessment of the remaining ocular
structures (fig. 1). Left eye hypotony recorded 5
mm Hg intraocular pressure.
The imaging tests performed (computed tomography and magnetic resonance) revealed the existence of an upper nasal paralimbic lacerated wound
approximately 10 mm long and the presence of a
full lens prolapsed into the subconjunctival space
(figs. 2 and 3).
Conjunctival chemosis evolved fast into a generalized hyposphagma, thus revealing the existence
CASE REPORT
A 74-year-old female patient arrived in the emergency room after having suffered a casual, mild and
traumatic contusion in the left eye at home, after
crashing against the nightstand.
Her personal history included slight ametropia
without optical correction and diabetes mellitus
type 2 treated with oral antidiabetics. No other significant personal or family history were found.
Her visual acuity (VA) was 0.6 in the right eye
and LE light perception not improving with stenopeic spectacles. Slit lamp examination revealed
hematoma and edema in the left upper eyelid, full
Fig. 1: Traumatic contusion in the left eye with hematoma and edema in the right upper eyelid.
642
Fig. 2: Computed tomography revealing full globe and
lens prolapsed into the subconjunctival space.
Fig. 3: Nuclear magnetic resonance confirms eye globe
integrity and the presence of the prolapsed lens.
ARCH SOC ESP OFTALMOL 2007; 82: 641-644
Traumatic dislocation of the lens
of a superior nasal subconjunctival mass (fig. 4)
corresponding to the prolapsed lens.
The patient underwent a 360º peritomy, extraction of the prolapsed lens, scleral wound suture and
treatment with reinforced intravenous and topical
antibiotherapy.
One month after surgery, the patient exhibited VA
of hand movement improving to 0.1 with + 14.00
diopter correction. The slit lamp revealed a transparent cornea, superior nasal corectopia with loss of
iris tissue and adhered remnants (fig. 5). The eye
fundus could not be observed due to media opacities. Ultrasound B mode showed the retina in place.
Twelve months later, surgery combining vitrectomy via pars plana and suture of the intraocular
lens to the sulcus (fig. 6) were performed, resulting
in spontaneous VA of 0.3 eighteen months later.
DISCUSSION
Several factors favor ocular rupture with lens dislocation in the event of traumas, even if these are
mild in intensity: advanced age results in rigid lenses and sclera, weakening pathologies in the eye
globe such as rheumatoid arthritis, scleritis or disorders affecting the connective tissue and, above all,
weakness resulting from prior surgeries, mainly large incisions such as lens extracapsular extraction
(1-4). These are the main factors altering the ocular
structure and responsible for those weak areas in
the comprehensible globe sphere suffering from
dehiscence caused by trauma.
Ocular rupture tends to occur in the superior
nasal sector due to the projection of energy caused
by the impact in the temporal region, where impacts
Fig. 4: Generalized hyposphagma and superior nasal subconjunctival mass corresponding to the prolapsed lens.
ARCH SOC ESP OFTALMOL 2007; 82: 641-644
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SANTOS-BUESO E, et al.
Fig. 5: Immediate postoperative period: aphakia and
superior nasal corectopia with adhered remnants and
loss of iris tissue.
occur more frequently (5). Energy is projected
towards the superior, posterior and nasal sectors;
the globe collides with the trochlea and orbital wall
(2-5). Rupture usually occurs at 2.5 mm and is concentric to the limbus, where tense and deep scleral
fibers are transformed into a delicate lamella of pectineous ligament (3).
The case described herein is rare, since ocular
rupture occurs as a result of mild trauma. Furthermore, the patient had not undergone any prior eye
surgery nor did she reveal any pathologies weakening the eye globe. This type of lesions tend to
result in suprachoroidal expulsive hemorrhages
with massive output of ocular content, a condition
not observed in the patient.
Staff in the Emergency Unit should seek to preserve the integrity of the eye globe and prevent
infections. Subsequently, the adequacy of surgery
should be assessed in order to recover as mach
visual functions as possible.
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Fig. 6: Intraocular lens sutured to the sulcus.
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3. Sony P, Khokhar S, Panda A. Traumatic lenticele. Clin
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4. Sathish S, Chakrabarti A, Prajna V. Traumatic subconjuntival dislocation of the crystalline lens and its surgical
management. Ophthalmic Surg Lasers 1999; 30: 684-686.
5. Yurkadul NS, Ugurlu S, Yilmaz A, Maden A. Traumatic
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