|Year : 2015 | Volume
| Issue : 2 | Page : 67-69
Posterior dropped crystalline lens by a car battery explosion ocular trauma
Department of Ophthalmology, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan
|Date of Web Publication||17-Dec-2015|
P.O. Box 10139, Khartoum 11111
Source of Support: None, Conflict of Interest: None
To report a case of right posterior dropped crystalline lens by a car battery explosion ocular trauma, in which the diagnosis was missed on initial ocular B-scan ultrasonography. Ocular injuries can be severe enough to compromise the vision, temporarily or permanently, depending on the type and mode of trauma itself; besides the urgency and competency of their managements. They often happen due to cars, sport, bombings, work, or war-related accidents. They can be penetrating or nonpenetrating injuries due to sharp or blunt impact causes; both can damage the structures at the front or at the back of the eye, with deferent degrees of severity. The prompt and competent emergency actions are the ophthalmic surgeons' challenges to save the vision. One of the not-uncommon eye traumas is due to the car battery explosions, which can lead to crystalline lens anterior or posterior dislocation. This case study will report the presentation and management of a posterior dropped crystalline lens by a car battery explosion, in which the diagnosis was missed on initial ocular B-scan ultrasonography.
Keywords: Bombings, car battery explosion, crystalline lens, sport, war accidents
|How to cite this article:|
Saleem M. Posterior dropped crystalline lens by a car battery explosion ocular trauma. Albasar Int J Ophthalmol 2015;3:67-9
| Introduction|| |
Facial and oculars trauma is the most common cause of seriously vision-threatening crystalline lens injuries, which are frequent consequence of both blunt and penetrating ocular trauma. They often occur due to accidental, sport, assault traffic accidents, car battery explosions, terrorist bombings (3–10%), work-related injuries, and wartime injuries.
Iatrogenic posterior dropped crystalline lens can occur during phacoemulsification as it is one of the serious complications of cataract surgery (0.1–1.5% of all cases) and rarely during intravitreal injection (0.006%).
Unilateral or bilateral posterior dislocation of the crystalline lens was reported after traumatic or postepileptic seizure. The trauma may involve the bony orbit, the eye itself, or both. They can be avoidable and preventable if safety and security measures are taken. Ocular trauma represented 10–15% of combat-related injuries during Desert Storm Gulf War (9%), Iraq, and Afghanistan wars.
Traumatic damage to the crystalline lens has diverse manifestations due to deferent physical mechanisms such as coup-countercoup mechanism of ocular injuries  and equatorial expansion mechanisms. This situation leads to contusion cataracts, capsular breaks, and zonular disruption with resultant anterior or posterior subluxation and dislocation in the case of partial or complete zonular dehiscence. Lens dislocation due to blunt force in anteroposterior direction leads to equatorial expansion, which disrupts the zonular fibers and dislocates the lens. Lens injuries occur in approximately 25% of cases of blunt injury of the globe.
B-scan ultrasonography can quickly establish to evaluate internal structures of the globe, media, hemorrhage, choroidal, or retinal detachment. Attention should be paid to signs of increased intraocular inflammation, infection, increased intraocular pressure, vitreous in anterior chamber (AC), or and vitreous traction.
A car battery is a type of rechargeable, 12 volt lead-acid, 6 (6 × 2.0 volts: 12 volts) cells made of plates of a lead storage battery that supplies electric energy to a car. Are made up of plates of lead and separate plates of lead dioxide, which are submerged into an electrolyte solution of 38% diluted sulfuric acid and 62% water. This causes a chemical reaction that releases electrons allowing them to flow through conductors to produce electricity through repeated recharge-discharge cycle chemical reaction (Battery Council International; resources)., This repeated chemical reaction generates hydrogen and oxygen by the electrolysis of water within its cells; this gas mixture is then vented from the battery via cell caps. The gas mixture is extremely explosive and should a naked flame or spark be generated in this atmosphere an explosive ignition can occur. The explosion may expel the acidic fluid contents of the cell (sulfuric acid) or may shatter the casing, hurling case and lead fragments about with great force. The potential for serious eye injury to a person working on a battery which explodes is apparent.
Car battery explosions ocular trauma
Car battery explosions ocular trauma has been seen in many car mechanic workshop areas anywhere in metropolitan cities, Khartoum not an exceptional. Injuries range from superficial acid burns to penetrating eye injury, retinal detachment, retinal hemorrhage, and crystalline lens injuries. The cause of the explosions has been ignition of the hydrogen-oxygen gas mixture generated by lead-acid batteries.
Most of the car battery explosions facial and ocular injuries happen to persons while charging the battery (26%), dealing with the battery cables (replacing, securing, or tightening); as a result of “jump starting" the battery (19%) or checking and adding fluid to the battery (19%).
To report a case of right posterior dropped crystalline lens by a car battery explosion ocular trauma, in which the diagnosis was missed on initial ocular B-scan ultrasonography.
| Case Report|| |
A 50-year-old Sudanese car's mechanic came to Sudan eye center immediately after right eye trauma. It was happened by a sudden severe car battery explosion onto his face; whereas, he measured the charge of a customer's car battery in his workshop. He had the habit not to wear any protective eyewear or safety goggles  while he is doing his mechanical or checking the customer's cars batteries work. He was referred from the general clinics downstairs to the retina clinic after they did for him the first aid managements and the vital systemic and ocular assessments. A B-scan was done for both eye but did not show much. The patient had severe right ocular pain, photophobia, and blurring of right eye vision when presented to our retinal clinic. On examination, the best-corrected visual acuity of the right eye was hand movement, the left eye was 6/6, cornea was clear, sluggish semi-dilated pupil of about 7 mm size. Minimal watery vitreous was seen in the AC with an intense AC activity but no hyphema. Through slightly hazy media a clear crystalline lens was found dropped inferiorly and toward the temporal side, with some hanging debris; in the posterior vitreous. There was very slight vitreous hemorrhage within slight turbid media. B-scan ultrasonography was repeated but the ophthalmic technician still could not get the picture of the dropped lens. Another scan was done carefully by the reporter himself to document the posterior fresh clear dropped crystalline lens [Figure 1]a,[Figure 1]b,[Figure 1]c. There were no ocular or facial acid burns that usually accompany these accidents. Minor forehead and right upper check contusions were hardly seen. Measures were taken to treat the traumatic intense inflammatory ocular reaction and booked for pars plana vitrectomy (PPV). The PPV was done successfully after nearly 2 weeks.
|Figure 1: (a-c) B-scan. With posterior dropped crystalline lens by a car battery explosion ocular trauma|
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- Mandatory wearing of protective eyewear, safety goggles, eye shields, and protective leather gloves by those dealing with car batteries
- Prompt first aids managements and the vital systemic and ocular assessments
- Early adequate irrigation to limit the duration of chemical exposure
- Point-of-care: Expert B-scan ultrasonography can rapidly identify the extent of the trauma
- Expedite senior specialist consultation
- Be aware of foreign bodies battery case fragments
- Car battery explosion ocular trauma requires prompt senior and tertiary management to avoid permanent serious ocular damage.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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