Unilateral uveitis, cataract and retinal detachment following low-voltage electrical injury

The paper presents a rare complication of electrical injury demonstrated as unilateral
uveitis, cataract and retinal detachment in a 39-year-old woman. Electrical injuries
are relatively uncommon. Electrical accidents can be classified according to whether
the current is high or low. Low-voltage electrical injuries are cases of exposure
of less than 1000 V and usually happen at home. Electrical injuries can cause a wide
variety of complications depending on the voltage, current, pathway and duration of
contact. Damages to the eye, occurring due to electric shock, rarely happen as a result
of accidents affecting the head. Herein, we report a patient with a unilateral uveitis,
cataract and retinal detachment, developed during the early period pursuant to a low-voltage
electrical injury. Written informed consent was obtained from the patient for publication
of this paper and any accompanying images.

A 39-year-old woman was brought to the emergency center at ?evket Y?lmaz Training
and Research Hospital as she had a low-voltage household electrical injury. When the
patient was brought to the emergency room, she had developed a cardiac arrest. She
was intubated and placed under treatment in the intensive care unit. She lost consciousness
for 1 week following the accident. At the time of admission, she had third-degree
burns on the right side of her leg. An ocular examination given in the course of admission
revealed normal findings without any corneal or lenticular opacity and evidence of
penetration or perforation of the globes. Apart from those findings, no symptoms of
electrical burns were observed on either of the eyelids and around the eyes. During
the four weeks of hospitalization, the patient suffered from a gradual worsening of
vision in the right eye. Her vision in right eye was limited to perception of hand
motions, with an intraocular pressure of 13 mmHg in each eye. In her right eye, a
slit-lamp examination showed non-granulomatous anterior uveitis with nuclear cataract
(Fig. 1). Fundus examination could not be carried out on the right eye. An ultrasound examination
also showed total retinal detachment (Fig. 2). The patient reported normal visual acuity in each eye before the injury. There
were no pathological findings in the left eye. There were no systemic or methabolic
changes which may cause cataract. The patient was treated with topical dexametazon
and %1 siklopentolat HCL ophthalmic solution four times daily and she was referred
to another center for vitreoretinal and cataract surgery. After cataract surgery combined
to pars plana vitrectomy with gas tamponade the patient’s postoperative Snellen visual
acuity at first month visit was 0.2.

Fig. 1. Photograph showed non-granulomatous anterior uveitis with nuclear cataract and ciliary
injection in the right eye

Fig. 2. An ultrasound examination showed total retinal detachment

The pathophysiologic features of electrically-induced ocular injury are complex and
the amount of tissue destruction depends on several variables, the duration of electric
current passage, the orientation of the cells in the current path, their location,
and other factors including the voltage, amperage and resistance 1]. Electrically-induced ocular injury has been associated with many pathologic changes
such as cataract, macular edema, eyelid edema, corneaepitelial keratitis, chemosis
and pupillary abnormalities 2]–5]. Among these, cataract is the most common complication 5]–7]. Less damage occurs in low resistant parts of the eye like retina and optic nerve
8]. The lens is the most sensitive tissue to electrical current and the resultant induced
heat in the eye 9].

In the previous studies of electrically-induced ocular injury the rates of cataract
have been documented to range from 1 % to 6 % 5], 10], 11]. Ferreiro et al. reported that the voltage does not have any influence on the severity
of the cataract and the current pathway, as well as its points of entry, does not
show any relation with the presence of renal failure, cardiac arrhythmia and cataracts
10]. ?n other study Solem et al. reported that the patients who had the cephalic region
had higher probability of developing cataracts 11]. Boozalis et al. reported that eight patients with cataracts and determine the characteristic
changes in lenses. All four patients with cataractous changes had characteristic anterior
subcapsular opacifications, except for one patient who presented with a dense white
opacified lens 5]. ?n our patient we detect ipsilateral nuclear cataract with relation between its
presence and the involvement of the ipsilateral region.

Uveitis, cataract and retinal detachment were detected in our patient during the four
weeks of hospitalization. Previous studies have generally reported cataract formation
as a late complication 5]–8]. Unilateral cataract may rarely be observed during the early recovery period of a
high-voltage electrical injury, and there are a few reports with unilateral ocular
complications 1], 12], 13]. The cataract appeared earlier and progressed faster in the eye nearer the site of
the electric shock 12], 13].

Several mechanisms have been postulated to cause retinal detachment, including mechanical,
thermal injury, or inflammation 9], 14]. The exact mechanism of unilateral uveitis, cataract and retinal detachment formation
after electrical injury is not known. Electrical current might have transmitted only
to the right eye or a sudden mechanical injury of vitreous may have resulted tractional
retinal detachment in our patient . Also, heat generated by the passage of a current
through the eye may cause various cellular or intercullular changes which possibly
result in uveitis, cataract and retinal detachment 10], 15].

In the cases of electrical injuries, physicians should be alert to these rare complications.
Patients who have experienced electrical injuries that affect especially the head
and the neck should be monitored regularly by an ophthalmologist in both early and
late period.