A 74-year-old female patient came to the emergency room after suffering a moderate intensity accidental blunt trauma at home in the left eye (LE), hitting the edge of the night table.
Among the antecedents stood out mild ametropia without optical correction and type 2 diabetes mellitus in treatment with oral antidiabetics.
She had no other personal or family history of interest.
His visual acuity (VA) was 0.6 in right eye and light perception that did not improve with stenopeic in left eye.
On examination with a slit lamp, the rest showed hematoma and edema of the upper left eyelid, intact conjunctiva with intense generalized chemosis, intact and transparent cornea and 100% hyphema that prevented evaluation.
Hypotonia of the left eye was observed with an intraocular pressure of 5 mm Hg.
Imaging tests (computed tomography and magnetic resonance) were performed, showing the existence of an incisive scleral paralimbar nasal wound of approximately 10 mm and presence of intact crystalline lens prolapsed space in the nasal cavity.
Generalized conjunctival chemosis rapidly progressed to hyposphagma allowing the presence of a superior nasal subconjunctival mass corresponding to the prolapsed crystalline lens to be appreciated.
The patient underwent a 360o peritomy, removal of the prolapsed crystalline lens, suture of the scleral wound and treatment with intravenous and topical antibiotics reinforced.
One month after surgery the patient had VA of hand movement that improved to 0.1 with correction of + 14.00 diopters.
A transparent cornea, superior nasal corectopia with loss of iridian tissue and attached remnants were observed in the cleft palate.
The eye fundus, which was not appreciated by media opacity, showed in situ retina at B-mode ultrasonography.
Twelve months later, combined pars plana surgery plus intraocular lens suture to sulcus was performed, achieving a spontaneous VA of 0.3 at 18 months.
