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Logo of mjafiGuide for AuthorsAbout this journalExplore this journalMedical Journal, Armed Forces India
 
Med J Armed Forces India. 1998 April; 54(2): 163–164.
Published online 2017 June 26. doi:  10.1016/S0377-1237(17)30515-4
PMCID: PMC5531376

SYMMETRICAL CATARACT FORMATION BOTH EYES DUE TO ELECTRIC INJURY OVER THE CENTRAL SCALP

(A Case Report)

Introduction

Lenticular opacities often appear some time after accidents involving exposure to voltage usually in excess of 1000 V, especially when entrance wounds are on head or neck [1]. A case of electric cataract is presented here which occurred after a rare type of entrance wound i.e. as a linear antero-posterior sagittal burn over the centre of scalp. Although this accident was something like a judicial electrocution yet the individual survived and later developed cataract.

Case Report

While sitting on a truck top a 17-year-old boy came in contact with a powerline carrying 11000 V. Entrance site was over the centre of scalp as a linear antero-posterior burn. In addition, he sustained burns on posterior aspects of both thighs. He remained unconscious for about an hour. He was given treatment of burns and became alright. He had no obvious burns of eyelids and periocular skin and he did not have any visual complaints at that time. One year after the accident he noticed decreasing vision in both eyes. Fourteen months after the injury his visual acuity was 6/36 in both eyes. The anterior segment examination was unremarkable except for the presence of anterior and posterior subcapsular cortical lens opacities that were bilateral and symmetrical. These opacities were like densly crowded layer of punctate dots forming a roughly circular faint disc in anterior and posterior subcapsular region. Nuclei were clear and fundi were normal. By the end of 18 months his visual acuity deteriorated to 3/60 OD and 2/60 OS. In both eyes anterior and posterior subcapsular opacities had become denser and there was involvement of a little deeper cortical layers. Cataract extraction with posterior chamber I0L implantation resulted in improvement of visual acuity to 6/6 OS.

Discussion

Electrical injury to the lens may result either by lightening stroke or by contact with a high tension conductor. The incidence of cataract formation usually varies between 5-20 per cent [1, 2], and depends on the strength of the current, duration of action of the current, distance of the area of contact from the eye and dryness of the skin. The strength of electric current involved when cataract has developed clinically, varies within wide limits from 500 V to even 80,000 V [3]. Cataract can be unilateral or bilateral.

The usual latent period varies from 1-18 months [3]. Most patients develop initial loss of vision within 12 months of injury. Anterior subcapsular changes are most common but posterior portion of lens also can be involved. Most affected eyes develop mature cataracts within 1 to 3 years. With effect of current there may be damage to capsule and subcapsular epithelium, jeopardising its semipermeability or damage to the protein in lens fibres which may in turn bring about osmotic changes.

The essential changes are probably intracellular. It is probable that the passage of a current through living cells produce effects of a microphysical nature at present unknown which in their ultimate stage appears as coagulation of protein. Morphological changes that evolve in the lens have been well described [4] but the exact pathophysiology of electric cataracts remain obscure [2, 5].

Treatment of electric cataract when it has caused significant visual deterioration is surgery. Any method of cataract extraction can be adopted. Intraocular lens can be implanted. Good visual results may be expected if the other structures of the eye like retina, optic nerve etc have escaped damage due to electric current [6, 7, 8]. Cases of electric injury should be followed up carefully because visual symptoms may develop late. Awareness by burn team members is essential in providing optimal treatment to victims of electrical injury.

REFERENCES

1. Saffle JR, Crandall A, Warden GD. Cataracts: A long term complication of electric injury. J Trauma 1985; 25: 17-21 [PubMed]
2. Portellos M, Orlin SE, Kozart DM. Electric cataracts. Arch Ophthalmol. 1996;114:1002–1003. [PubMed]
3. Duke-Elder S. Injuries. In : System of Ophthalmology. St Louis: CV Mosby. 1971:829–830.
4. Thomas AH, Hanna C. Electric Cataracts 111: Animal model. Arch Ophthalmol 1974; 91: 469-73 [PubMed]
5. Long JC. A clinical and experimental study of electrical cataract. Trans Am Ophthalmol Soc. 1962;60:471–516. [PubMed]
6. Biro Z, Pamer Z. Electrical cataract and optic neuropathy. Int Ophthalmol. 1994;18:43–47. [PubMed]
7. Boozalis GT, Purdue GF, Hunt JL, MC Culley JP. Ocular changes from electrical burn injuries. J Burn care Rehabil 1991; 12: 458-62 [PubMed]
8. Al Rabiah SM, Archer DB, Millar R, Collins AD, Shephered WF. Electrical injury of the eye. Int Ophthalmol. 1987;11:31–40. [PubMed]

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