26.1 Introduction

Ocular trauma is one of the causes of visual impairment and is commonly encountered in young patients who are associated with sports and recreational activities. Elderly people most commonly report ocular trauma after a fall that can be due to gait disturbances, neurological deficits, or may be accidental. Ocular trauma can be broadly categorized into a blunt or penetrating trauma and it may be a closed or open wound injury. Following blunt ocular trauma, scleral rupture is most commonly observed at superonasal and temporal quadrants. The presence of supraorbital rim and nasal bridge makes the temporal and inferior quadrants more susceptible to trauma. ^{1 , 2 , 3} Hence, post-trauma scleral rupture is commonly observed in the superonasal and temporal quadrants.

As a sequelae to trauma, the seven rings of ocular tissue are affected, namely, sphincter pupillae, the iris base, anterior ciliary body, detachment of ciliary body to the spur, trabecular meshwork, zonular detachment, and retinal detachment. ⁴ Depending upon the type of injury and the impact of trauma, the clinical scenario differs in presentation and prognosis. The terms phacocele and pseudophacocele indicate extrusion of the natural crystalline lens in a phakic eye and of the intraocular lens implant in a pseudophakic eye into the subconjunctival space (▶Video 26.1 and ▶Video 26.2).

26.2 Phacocele

The concussive force due to blunt trauma damages the zonular integrity and pushes the crystalline lens through the ruptured scleral wall ⁵ into the subconjunctival space (▶Fig. 26.1). Alternatively, the crystalline lens can also be pushed back into the vitreous cavity. The patients typically present with a history of blunt trauma associated with pain and dimness of vision. In patients with phacocele, slit lamp examination (SLE) demonstrates aphakia with subconjunctival or a sub-Tenon’s mass, which is probably the extruded crystalline lens. Often the anterior chamber (AC) details are obscured due to hyphema and vitreous hemorrhage.

26.3 Pseudophacocele

Biedner et al, ⁶ who first reported the subconjunctival extrusion of an IOL (▶Fig. 26.2) associated with globe rupture following blunt ocular trauma, formulated the terminology of “pseudophacocele.” The traumatic rupture and gaping of the surgical wound have been reported even after 12 years of surgery. The surgical wound healing is a slow process and is often delayed due to associated diseases. ^{7 , 8 , 9 , 10} Wound healing after cataract extraction is a slow process and traumatic wound rupture is not uncommon.