Cataract by electrocution.

Case report
MD. Eliana Duarte Fariña 
Hospital de Clinicas
Guillermo Raúl Vera 
(

guillermoveraduarte@gmail.com
)
Hospital de Clinicas
https://orcid.org/0000-0002-3417-256X
Martin Arrúa 
Hospital de Clinicas
Luis Gonzalez 
Hospital de Clinicas

Research Article

Keywords: ophthalmology evaluation, electrical accident, X-rays, radiation therapy, radioactive materials

Posted Date: July 26th, 2021

DOI: https://doi.org/10.21203/rs.3.rs-730234/v1

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Abstract
Introduction

Electrical burns generate a special type of injury. the longer a person is exposed to electricity, the worse
the injuries will be. Cataracts resulting from this mechanism are of low frequency.

Case

we present a case of a cataract secondary to an electrical accident, whose vision worsened over time,
which led him to the service consultation.

Discussion

The formation of cataracts after various types of exposure to electricity has been reported but the exact
pathogenesis of electrical cataract is controversial, and several theories have been proposed.

Conclusion

This type of accident or events related to electrocution should have a complete routine ophthalmology
evaluation, as soon as the patient is stable. Although they turn out to be a minimal cause of frequency,
you should think about the possibility of their existence. Generally, these cases, without previous
affections is considered to have a good visual prognosis.

Introduction
Electrical burns generate a special type of injury, derived from the physical properties of electricity and the
path of current flow through tissues and organs, causing superficial or multi-organ involvement (1). The
path that the current takes in the body usually determines the possible tissues that will be affected.

The hand being the most frequent point of contact of the electrical source, the second is the head. The
longer a person is exposed to electricity, the worse the injuries will be. Cataracts resulting from this
mechanism are of low frequency.

Cataract is a clouding of the lens that can be due to a variety of causes (2). These include traumatic
cataracts, which may be due to different mechanisms such as related to foreign body injury to the lens or
blunt trauma to the eyeball. And rarer causes from excessive exposure to heat, X-rays, radiation therapy,
radioactive materials, and electricity (2).

The case of a patient with the diagnosis of cataract due to electrocution is presented, which manifested
with loss of visual acuity months after an electrocution event.

Clinical Case

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A 22-year-old male patient, from a rural area, a gardener by profession, with a history of electrocution with
loss of consciousness for approximately 2 hours, was hospitalized and placed under surveillance for 1
month; he required reconstructive surgeries at the level of the right hemisphere due to injuries typical of
the accident, and a supratrochlear amputation of the right leg was performed (Figs. 1 and 2).

He visited the ophthalmology service 4 months after the event due to a history of progressive decrease in
visual acuity in the right eye. The physical examination revealed a significant leukocoria of the right eye,
scarring lesions at the level of the right hemisphere and amputation of the right MI. In the
ophthalmological evaluation of the Right Eye (RE), a visual acuity (VA) of Hand Movement without
improvement, intraocular pressure (IOP) 12 mmHg, positive photomotor reflex and as soon as the anterior
segment was observed a clear conjunctiva, transparent cornea, anterior chamber formed, wide and white
cataract with opacities at the level of the anterior capsule (Fig. 3). As for the left eye (LE), a visual acuity
of 20/20 was observed, IOP 13, positive photomotor reflex; At the anterior capsular and subcapsular level,
minimal opacities were observed. The auxiliary method of the right eye ultrasound was requested, which
reported an increase in echogenicity and anteroposterior diameter of the lens, the other structures were
found without valuable data.

Phacoemulsification was performed with trypan blue capsular staining prior to capsulorhexis and
implantation of a foldable IOL in a capsular bag, without complications.

On the 5th postoperative day, a transparent corneal RE, slight inflammation, IOL in the capsular bag, a
20/20 VA without correction was observed.

Discussion
The formation of cataracts after various types of exposure to electricity has been reported, among which
examples can be cited in electrical cardioversion, electrocution in an electric chair and in accidents due to
electrical burns (3). For unknown reasons, electroconvulsive therapy does not cause cataracts (4).

The reported incidence of cataracts in patients with electrical injuries ranges from 0.7–8.0% (3). It is
assumed to be due to differences in the voltage and duration of action of the current, the distance of the
eye contact area, the extent of the surface contact, and the direction the current takes in the body. It will
depend on whether these factors are more focused towards the eye. The strength of the electrical current
that causes cataract formation is considered to vary between 220 to 80,000 volts (5).

The appearance of cataracts as a consequence of severe electrocution, in the Department of

Ophthalmology at Yale Hospital, has been reported with an incidence of up to 5% in patients with current
entry points on the neck (6). The exact pathogenesis of electrical cataract is controversial, and several
theories have been proposed (3). The characteristics of this type of cataract usually present with edema
of the lens, which progresses rapidly to a mature one due to increased proliferation and rupture of lens
fibers. In relation to our case, the patient had contact through the right arm while doing gardening work

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and only reported progressive decrease in vision in the right eye that was accentuated 4 months after the
accident.

Electrocution cataracts may manifest immediately as well as sometime later, from days to months, even
years. A latency period of up to 11 years after the event has been reported (7).

Conclusion
This type of accident or events related to electrocution should have a complete routine ophthalmology
evaluation, as soon as the patient is stable. Although they turn out to be a minimal cause of frequency,
you should think about the possibility of their existence. There is no large sample study, so it would be an
important public health issue to consider.

Generally, these cases, without previous affection, are accompanied by a good state of the optic nerve as
well as the retina, for which a correct diagnosis and elective surgery without complications is considered
to have a good visual prognosis.

Declarations
Declaration of conflicting interests 

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article. 

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article. 

Informed consent 

The patient gave her informed written consent to publish the case and the images.

References
1. Price T, Cooper MA Electrical and Lightning Injuries. Emergency Medicine. pag.1893–1902
2. Shock JP, Harper RA. Cristalino. En: Vaughan DG, Asbury T, Riordan-Eva P. Oftalmología General, 11°
Edición, 1997, Editorial Manual Moderno, S.A. Capítulo 8, pg 191–201
3. Duke-Elder S, MacFaul PA. Injuries; Non-Mechanical Injuries. In: Duke-Elder, ed, System of
Ophthalmology. London, Henry Kimpton, 1972; Vol XIV, Part 2, 813–835
4. Koskenoja J, Runeberg C (1958) Does electric convulsive therapy cause cataract? Acta Ophthalmol
(Copenh) 36:102–109

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 5. Godtfredsen E (1942) Cataracta electrica and electrocardiographic changes after electric shock. Acta
Ophthalmol (Copenh) 20:69–79
6. Seth RK, Abedi G, Daccache AJ, Tsai JC (2007) Cataract secondary to electrical shock from a Taser
gun. J Cataract Refract Surg 33:1664–1665
7. Skoog T (1970) Electrical injuries. J Trauma 10:816–830

Figures

Figure 1

Secondary lesions at the level of the hemicranium.

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Figure 2

Supratrochlear amputation of the right leg.

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Figure 3

Leukocoria at the level of the right eye.

Figure 4

Biomicroscopic Image of the Right Eye.

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