Early-Onset Lens Sclerosis In A Hyperbaric Chamber Technician: A Potential Occupational Effect Of Chronic Hyperoxia

To report a striking case of early-onset bilateral combined cerulean and nuclear sclerosis in a hyperbaric chamber technician without conventional cataract risk factors, and to explore the hypothesis that chronic occupational exposure to hyperbaric oxygen may accelerate cataractogenesis. While hyperbaric oxygen therapy is known to induce transient myopic shifts and has been associated with lens sclerosis after prolonged therapeutic exposure, its potential occupational implications remain underexplored. This report aims to raise awareness of a possible occupational risk factor for accelerated lens opacification.

Single case from a tertiary hospital hyperbaric medicine unit involving a male technician with long-term occupational exposure to near-daily hyperbaric oxygen sessions. A detailed clinical and occupational history was obtained, excluding conventional cataract risk factors. A comprehensive ophthalmological examination performed five years earlier documented a clear crystalline lens. Current assessment included slit-lamp biomicroscopy, best-corrected visual acuity, and lens opacity grading.

A 44-year-old male hyperbaric chamber technician was referred for evaluation of bilateral lens opacities detected on routine examination. He denied visual complaints, including glare, blurred vision, or refractive changes. Best-corrected visual acuity was preserved in both eyes. Intraocular pressure was 17 mmHg bilaterally, and fundus examination was unremarkable. Slit-lamp biomicroscopy revealed bilateral, symmetrical lens changes characterized by prominent cerulean cortical opacities associated with early nuclear sclerosis. No posterior subcapsular involvement was observed. The patient denied a history of diabetes mellitus, systemic or topical corticosteroid use, uveitis, ocular trauma, ionizing radiation exposure, or family history of cataract. A comprehensive ophthalmological examination performed five years earlier documented a clear crystalline lens without lenticular abnormalities. Occupational history was notable for chronic hyperoxic exposure. The patient had been working as a hyperbaric chamber technician for 18 months prior to presentation, with near-daily exposure to hyperbaric oxygen sessions as part of his professional duties. No other relevant occupational or environmental exposures were identified.

Lens sclerosis associated with hyperbaric oxygen exposure is uncommon and has been reported mainly in patients undergoing prolonged or high cumulative therapeutic exposure, with cataract formation remaining rare and exceptional in occupational settings. This case highlights a potential occupational cataract risk related to chronic, non-therapeutic hyperoxic exposure in a hyperbaric technician without conventional risk factors. Although causality cannot be established from a single case, these findings support the hypothesis that repeated occupational hyperoxia may contribute to accelerated lens changes. Increased awareness and ophthalmological surveillance may help detect early lens alterations and address a gap in occupational eye health.