About the Journal | Editorial Board | Instructions to Contributors | Submission & Review | Advertise with Us | Subscribe to E- Alerts
Sitemap | Feedback | Follow Us 
Advanced search
The Official Scientific Journal of Delhi Ophthalmological Society
Bilateral Electric Shock Induced Cataract
Ambika  Chandak, Anju Kochar, Poonam Bhargava
Department of Ophthalmology, Sardar Patel Medical College, Bikaner, India 

Corresponding Author:
Ambika Chandak MS 
Resident 
Department of Ophthalmology , 
Sardar Patel Medical College, Bikaner, India 
Email id: drbrajesh79@gmail.com
Received: 04-NOV-2017 Accepted: 22-DEC-2017 Published Online: 05-MAR-2018
DOI: http://dx.doi.org/10.7869/djo.342
Abstract
Electric shock injury may cause various ocular complications. The severity of the complications depends on the voltage and site of passage of electric shock. The probability of ocular involvement rises more if the injury occurs at the scalp or face. Electric shock induced cataract is usually bilateral. The exact  pathogenesis of cataract development is unknown. Direct coagulation of lens proteins and the osmotic changes following damage to the subcapsular epithelium are thought to be  responsible. Other ocular complications like  conjunctival hyperemia, interstitial corneal opacities, uveitis, miosis, spasm of accommodation etc may occur. Some rare complications like optic nerve coagulation, necrosis of retina, choroid and optic atrophy have been reported. Macular oedema may lead to the development of macular cysts or holes. Paresis of extraocular muscles have been frequently observed.
We report two rare  cases of high voltage electric injury in two young male patients resulting in bilateral cataract. No other ocular complications were encounterd. Entry and exit wounds were present in both the patients. Fundoscopy, Ultrasound B – scan and  OCT were done to evaluate the posterior segment which were normal .  Patients underwent manual small incision cataract surgery (MSICS) with posterior chamber intra ocular lens implantation  with good post operative visual recovery. The study concludes  that the degree of lenticular change seems to bear no definite relation to the strength of the current and with proper evaluation of posterior segment we can predict the post operative visual recovery.

Keywords : electric shock, bilateral, cataract

Introduction
Electrical shock causes many ocular complication varying from simple conjunctival hyperemia to severe retinal detatchment or retinal necrosis. The most common complication encountered is cataract which is mostly bilateral. The exact pathogenesis of cataract formation is not known but it is presumed that electricity shock cause protein coagulation and cataract formation. Lens manifestations are more likely when the transmission of current involves the head of the patient. Initially, lens vacuoles appear in the anterior midperiphery of lens, followed by linear opacities in the anterior subcapsular cortex. A cataract induced by an electrical injury may regress, remain stationary, or mature to complete cataract over months or years. Here is a case report of two patients who developed bilateral cataract after electrocution.

Case Report 1 
A 15 year old male child presented to us in May 2016 with the complaints of gradual, painless, progressive diminution of vision in both eyes after the electric burns on the face and neck by accidental electrocution 5 years back while travelling by bus in which he was seated on the carrier. There was an entrance wound at the forehead (Figure 1) and face on the temporal side and an exit wound at the neck (Figure 2).




On ocular examination, visual acuity was 6/18 J3 in the right eye and 6/60 J5 in the left eye. In both eyes, pupils were normal and reactive. On slitlamp examination, anterior subcapsular linear opacities were seen in both eyes and was more dense in the left eye (Figure 3,4). On ophthalmoscopy, right eye fundal details were within normal limits and left eye details could not be seen. USG B scan and OCT was carried out which revealed normal posterior segment in both eyes. Biometry and routine blood (Fasting blood sugar, haemoglobin, bleeding time and clotting time) and urine examination were within normal limits. He was subsequently posted for left eye cataract surgery with PCIOL implantation. An uncomplicated left eye MSICS cataract surgery was performed with monofocal foldable PCIOL implantation. The patient was given routine post operative systemic antibiotics for 5 days and topical steroids for 6 weeks with reducing frequency. Regular follow ups were performed and at 6 weeks, BCVA 6/6 J1, post operative OCT was within normal limits and no other complications were seen. The patient was advised to undergo cataract surgery in the right eye but he was not willing. 


Case Report 2
A 23 year old male patient, electrician by profession, presented to us in June 2016 with complaints of gradual diminution of vision in both eyes after electric burns on the head 1 yr back ,while working on an electric pole.

On examination, a bone deep burn scar mark of entry wound was seen on the forehead which was already operated by left hand pedicle graft (Figure 5) 1 year back. In spite of grafting, a large opening of frontal sinus was present on the forehead for which the patient was advised to undergo second surgery by a plastic surgeon. An exit wound was seen in the right foot with amputation of the little toe (Figure 6).

There was history of surgery in the right eye for cataract elsewhere 4 months back. On ocular examination, the right eye had pseudophakia, operated 4 months back for electric burn cataract, BCVA was 6/6p J1. On left eye examination, a total mature white cataract was present with Perception of light and accurate PR. In both eyes, pupils were normal and reactive. In the right eye, fundal details were normal and the left eye details could not be seen. USG B scan revealed a normal posterior segment. Biometry and routine blood (Fasting blood sugar, haemoglobin, bleeding time and clotting time) and urine investigations were within normal limits. 
He was subsequently posted for left eye cataract surgery with PCIOL implantation. An uncomplicated left eye MSICS cataract surgery was performed with monofocal foldable PCIOL implantation. The patient was given routine post operative systemic antibiotics for 5 days and topical steroids for 6 weeks with reducing frequency. Regular follow ups were performed and at 6 weeks, BCVA was 6/6p J1, post operative OCT was within normal limits and no other complications were seen.

Discussion 
Electrical cataracts may occur following contact with high tension conductor1, lightning2 or electric shock therapy. Only few cases of electric cataract have been reported in the literature, probably because few patients survive the high voltage of current that induces cataract formation. Cataract usually occurs 1-12 months3 after the accident and is frequently associated with no other observable ocular damage. An incidence of 6.2% is seen following electrical injury.3 However, the degree of lenticular change seems to bear no definite relation to the strength of the current.4 In most cases, the electric current has passed through the head in the vicinity of the eye with a contact electrical burn. Entrance and exit wounds are seen. It is found that the young lens is more liable to damage than the sclerosed lens of age like our cases. The exact pathogenesis of cataract development is unknown. Direct coagulation of lens proteins and the osmotic changes following damage to the subcapsular epithelium are thought to be responsible.5 Scale like grey opacities may form in the capsule and more characteristically in the subcapsular layers of the cortex, usually the anterior cortex like in case 1, though the posterior cortex may also be affected. The clinical course of the cataract varies. Regression may occasionally occur, they may remain stationary, or maturation may occur slowly over an average period of 6 months. Sometimes with startling rapidity after a long static period, the cataract may mature to complete milkiness resembling hammered silver or mother of pearl. The cataract may become intumescent and as a rarity cause acute angle closure glaucoma as it swells. A typical electric burn may occur at the point of contact leaving its imprint as a sharply defined necrotic mark without surrounding hyperemia. A similar exit wound may be seen. Other lesions7 affecting the eye are conjunctival hyperemia, interstitial corneal opacities, uveitis which may be mild or severe, miosis, spasm of accommodation etc. Electric energy can damage the lens, retina and choroid. Optic nerve coagulation, necrosis of retina, choroid and optic atrophy have been reported.6 Retinal oedema, papilloedema and haemorhages with patches of chorio-retinal atrophy in the periphery, rupture of choroid, optic neuritis or even retinal detachment may occur.7 Macular oedema may lead to development of macular cysts or holes. Paresis of extraocular muscles have been frequently observed. In the given patients, typical entrance and exit wounds could be seen and except cataract, the eyes had otherwise not been damaged. However MICS followed by posterior chamber intraocular lens implantation in the bag resulted in stable and good visual acuity. Our study concludes that prior to surgical management, it is better to evaluate the posterior segment with the help of USG B scan and OCT to rule out any pathology which can affect the post operative visual recovery. Thus it can be concluded that proper surgical management of electric cataract will result in a good visual rehabilitation if the eye has otherwise escaped damage as in these cases.

References
  1. Boozalis GT, Purdue GF, Hunt JL, McCulley JP. Ocular changes from electric burn injuries. A literature review and report of cases.J Burn Care Rehabil. 1991; 12:458-62.
  2. Noel LP, Clarke WN, Addison D. Ocular complications of lightning. J Paediatric Ophthalmol Strabismus  1950; 17:245-6.
  3. Saffle JR, Crandall A, Warden GD. Cataracts a long term complication of electrical injury. J Trauma 1985; 25:17-21.
  4. Stewart Duke Elder, Peter A Macfaul, System of Ophthalmology, Vol XIV-2, Non-Mechanical Injuries, The C V Mosby Company,St Louis, 1972, p 815-835
  5. Manuel Batiles, Benjamin V Magno, Duane’s Clinical Ophthalmology Vol I,Chapter 73, Cataract-Clinical Types,Lippincott-Raven Publishers, Philadelphia, New York, 1996, p 22
  6. Archer DM: Injuries of posterior segment of eye. Tran Ophthal Soc UK 1985; 104:597.
  7. Paul Dieckert, Albert and Jakobiec, Principles and Practice of Ophthalmology, Vol. 5, Chapter 277, Posterior Segment Trauma,W B Sonders Company, Philadelphia, 1994, p 3419



Article Options
FULL TEXT
ABSTRACT
PDF
PRINTER FRIENDLY VERSION
Search PubMed for
Search Google Scholar for
Article Statistics
CITE THIS ARTICLE
Ambika Chandak, Anju Kochar, Poonam BhargavaBilateral Electric Shock Induced Cataract.DJO 2018;28:69-71
CITE THIS URL
Ambika Chandak, Anju Kochar, Poonam BhargavaBilateral Electric Shock Induced Cataract.DJO [serial online] 2018[cited 2019 Jan 16];28:69-71. Available from: http://www.djo.org.in/articles/28/3/BilateralElectricShockInducedCataract.html
Bookmark and Share