Long-Term Consequences Of Childhood Ocular Trauma: A Clinical Approach

Corectopia refers to an eccentric deviation of the pupil from the visual axis. While most cases involve minor congenital deviations without clinical significance, traumatic injuries are a common secondary cause, frequently overlooked in the developed world. These injuries often manifest with anterior or posterior synechiae, areas of iris atrophy, corneal scarring, or lens subluxation, all of which can significantly impair visual acuity. This case report aims to present a clinical approach to managing a patient with a history of childhood ocular trauma and its subsequent impact on ophthalmological treatment many years later. 

Ophthalmology Department, Hospital de Egas Moniz – Unidade Local de Saúde de Lisboa Ocidental, Lisbon, Portugal

The authors present a case of an 84-year-old male with a history of left eye (LE) trauma from a stone incident 79 years prior. The patient reported no previous surgical intervention or ophthalmological management related to this injury. 

On examination, his best corrected visual acuity (BCVA) in the LE was 0.2. Slit-lamp examination revealed a deep corneal scar in the inferior temporal quadrant associated with a large anterior synechiae of the iris, resulting in significant corectopia. This was consistent with a past transfixed corneal wound. No evidence of iridodonesis, phacodonesis or lens subluxation was observed.

The low BCVA in the LE was attributed to several factors, including amblyopia, irregular astigmatism, corectopia, and senile cataract. 

As no improvement in BCVA was observed after slight mydriasis, the patient underwent LE phacoemulsification without pupil management.  Postoperative LE BCVA slightly improved to 0.3. However, due to the significant obstruction of the visual axis, an Nd:YAG laser iridotomy was attempted. A small laser sphincterotomy along the nasal border of the pupil was performed, with only a localized, self-limited hemorrhage. In the subsequent visit, the BCVA in the LE improved to 0.5 with no associated glare or complaints of high-order aberrations.

Antique ocular trauma and its sequelae present significant challenges later in life, particularly when the patient requires surgery for other ocular conditions, such as cataracts. Careful preoperative planning is essential, considering potential complications and intraoperative difficulties associated with distorted eye anatomy. Challenges persist after surgery, and sometimes unconventional approaches, as demonstrated in this case, become necessary to achieve good visual acuity.