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ARTICLES
Year : 1976  |  Volume : 24  |  Issue : 4  |  Page : 31-32

Sub-conjunctival dislocation of lens-a case report


Kankubai Eye Hospital, Solapur, India

Correspondence Address:
M V Albal
Padma, Hotgi Road, Solapur-413003
India
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Source of Support: None, Conflict of Interest: None


PMID: 303617

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How to cite this article:
Albal M V, Kalyani R S. Sub-conjunctival dislocation of lens-a case report. Indian J Ophthalmol 1976;24:31-2

How to cite this URL:
Albal M V, Kalyani R S. Sub-conjunctival dislocation of lens-a case report. Indian J Ophthalmol [serial online] 1976 [cited 2019 Oct 22];24:31-2. Available from: http://www.ijo.in/text.asp?1976/24/4/31/31281

Extra-Ocular dislocation of lens can occur following concussion of sufficient force to cause repture of the globe. Very few cases of this type of dislocation in subconjunctival space have been reported.[1],[2],[4],[5]


  Case Report Top


A female aged 50 years reported to the O.P.D of Smt. Kankubai eye hospital, complaining of loss of vision in both eyes, following a blunt injury with fist on the right eye about 2 months back.

On examination the right eye a bulge was seen in the upper fornix. The cornea was ;:.tear, the anterior chamber was deep and pupil was drawn up. A perfor ation at the sclero-corneal junction was seen between 10 o'clock and 1 o'clock position. The pearly lens was in the sub-conjunctival space in the upper fornix. [Figure - 1]

The vision in the left eye was finger counting 2 feet. The eye showed ciliary congestion, K.P.s, aqueous flare and posterior synechiae. All the signs of sympathetic ophthalmia were present.

The patient was put on betamethasone 3 mgs. per day along with antibiotics before operation. The opera­tion was performed after a week.

The lens was taken out with a conjunctival incision extending from 10 o' clock to 2 o' clock at the limbus. It was adherent to the episcleral tissue but could be taken out without rupturing the capsule. The sclero­corneal perforation had sealed and hence it was not disturbed. The incision was closed with only conjunc­tival stitches.

Betamethasone 3 mgs. daily along with antibiotics was continued for 5 days and then gradually tapered off.

The post-operative period was quite uneventful. The wound healed well. The left eye also showed improve­ment with decrease in K.P.s and aqueous flare.

On the day of discharge the vision in right eye was finger counting at 1 foot and in the left eye finger count at 3 feet.


  Discussion Top


Lens is known to get dislocated after con­cussion injury of the eye. Displacement of lens has been classified by Sir. S. Duke-eider[3] in the following scheme.

(A) Subluxation.

(B) Luxation or dislocation.

(i) incarcerated in the pupil. (ii) in the anterior chamber. (iii) in the vitreous. (iv) in the sub-retinal space. (v) it may wander from one place to other (Wandering lens.) or (vi) It may be extruded out of the globe.

A blunt injury of sufficient force causes a backward thrust and rebounding of the lens. The pressure wave of the aqueous forces the root of the iris backwards, whereas the vitreous recoil forces it anteriorly, The lens is also pushed forward due to the recoil of the vitreous. Due to this antero-posterior compression of the globe and the compensa­tory sudden enlargement of the sclero-corneal ring, there is a stretch and tear of the delicate tissues. As a rule the zonule itself is injured with a resulting sub-luxation or luxation of the lens. Frequently the lens is either sub-luxated or completely dislocated in the anterior cham­ber or even more commonly, it is dislocated in the vitreous.

If the concussion is of sufficient force, there is a likelyheod of tear of the sclera either at the sclero-corneal junction or at the equator, along with complete dislocation of the lens. The lens escapes through this rent in the sclera and gets lodged under the conjunctiva.

Sub-conjunctival dislocation of lens has been reported by Bhaduri[1] in a peculiar case when dislocation was due to a leaping fish.

Chams and Sadoughi[2] have reported 5 cases, of which one had developed sympathetic ophthalmia, while Sedan' reported having seen nine such cases during a period of 30 years.


  Summary Top


In this communication, we have to report a case of sub-conjunctival dislocation of lens following blunt injury with fist. She developed sympathetic ophthalmia in the other eye. The patient received betamethasone and antibiotics for one week and also post-operatively. The lens was removed through a conjunctival incision. No post-operative complications occured. The recovery after the removal of lens was good and the patient recovered partial vision.


  Acknowledgements Top


The authors are thankful to the authorities of Smt. Kankubai Eye Hospital, Solapur for the permission to publish this case.

 
  References Top

1.
Bhaduri, 1955, J. of All India Ophthal. Soc., 3, 17.  Back to cited text no. 1
    
2.
Chams and Sadoughi, 1957 Acta Med. Iran., 1 , 299 as cited by Duke Elder, 1972, Sys. of Oph­thal., 14, 142, Henry Kimpton, London.  Back to cited text no. 2
    
3.
Duke-Elder, S. 1969, Sys. of Ophthal., 9, 300, Henry Kimpton, London.  Back to cited text no. 3
    
4.
Duke Elder, S., 1972, Sys. of Ophthal., 14, 142, Henry Kimpton, London.  Back to cited text no. 4
    
5.
Sedan, 1961, Ann. Oculist, Paris, 194 ,727, as cited by Duke Elder, S., 1972, Sys. of Ophthal., 14, 148, Henry Kimpton, London.  Back to cited text no. 5
    


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