|Year : 1976 | Volume
| Issue : 4 | Page : 31-32
Sub-conjunctival dislocation of lens-a case report
MV Albal, RS Kalyani
Kankubai Eye Hospital, Solapur, India
M V Albal
Padma, Hotgi Road, Solapur-413003
Source of Support: None, Conflict of Interest: None
|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
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.,,,
| Case Report|| |
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|| |
Lens is known to get dislocated after concussion injury of the eye. Displacement of lens has been classified by Sir. S. Duke-eider in the following scheme.
(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 in a peculiar case when dislocation was due to a leaping fish.
Chams and Sadoughi 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|| |
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|| |
The authors are thankful to the authorities of Smt. Kankubai Eye Hospital, Solapur for the permission to publish this case.
| References|| |
Bhaduri, 1955, J. of All India Ophthal. Soc., 3, 17.
Chams and Sadoughi, 1957 Acta Med. Iran., 1 ,
299 as cited by Duke Elder, 1972, Sys. of Ophthal., 14,
142, Henry Kimpton, London.
Duke-Elder, S. 1969, Sys. of Ophthal., 9,
300, Henry Kimpton, London.
Duke Elder, S., 1972, Sys. of Ophthal., 14,
142, Henry Kimpton, London.
Sedan, 1961, Ann. Oculist, Paris, 194 ,727,
as cited by Duke Elder, S., 1972, Sys. of Ophthal., 14,
148, Henry Kimpton, London.
[Figure - 1]