Posterior Dislocation Of The Lens Following Low-Energy Blunt Ocular Trauma From A Clothing Accessory

To report an unusual case of posterior dislocation of the lens following minor blunt ocular trauma from a clothing accessory, and to highlight the importance of careful anterior and posterior segment assessment, including B-scan ultrasonography, particularly in patients with a history suggestive of prior zonular compromise.

Emergency ophthalmology assessment in a secondary care hospital in the United Kingdom, with subsequent referral to vitreoretinal services.

A phakic woman in her sixties presented with acute painless visual loss in the right eye following low-energy blunt ocular trauma caused by recoil of a metal aglet on a coat hood drawstring. There was no associated fall, loss of consciousness, or high-velocity injury. She reported a history of remote blunt trauma to the same eye several years previously, with no history of ocular surgery or known connective tissue disease.

On examination, best-corrected visual acuity was markedly reduced in the affected eye, with normal findings in the fellow eye. Intraocular pressure was within normal limits. Slit-lamp examination demonstrated aphakia with vitreous prolapse into the anterior chamber and pigment dispersion, without hyphaemia, iris dialysis, or corneal injury. Fundus view was limited.

B-scan ultrasonography confirmed an intact lens lying within the inferior vitreous cavity, with no evidence of retinal detachment or vitreous haemorrhage. A diagnosis of traumatic posterior dislocation of the lens was made. The patient was managed conservatively with topical corticosteroids and referred urgently for vitreoretinal assessment. Surgical intervention was planned for visual rehabilitation and prevention of secondary complications.

Low-energy blunt trauma from everyday clothing accessories can result in significant intraocular injury, including posterior lens dislocation, particularly in eyes with pre-existing zonular weakness. In the UK, there is no clear regulation addressing the ocular risk posed by rigid metal aglets on hood drawstrings. The use of softer materials, such as plastic, may reduce this type of injury. Greater awareness of this preventable mechanism is warranted.