Severe Blunt Ocular Trauma: Reconstructing and Rehabilitating—Test of Patience!

Blunt trauma can have devastating effects on the eye. We describe the ocular effects of an assault injury, the diagnostic dilemmas that we had to resolve, and planned stepwise surgery to achieve the best visual results in such an eye. A 66-year-old male presented with severe trauma of the left eye. The primary repair had been done at a peripheral center. He had a vision of hand movements close to the face with accurate projection of rays, high intraocular pressure, and large irregular corneal sutured wound superiorly, and the anterior chamber was full of blood. The iris, lens, and fundus were not visible. The right eye had a grade 4 nuclear sclerosis with the vision of counting fingers at 1 m. The rest of the eye appeared normal. Surgery was perfomed in a stepwise manner : the left eye was cleared of hyphaema, vitreous hemorrhage was removed via pars plana vitrectomy. No dislocated intraocular lens (IOL) was found in the vitreous cavity. IOP was controlled with anti glaucoma drugs. Manual small incision cataract surgery was performed in the right eye ensuring visual rehabilitation. Intraocular pressure control and visual rehabilitation were tackled together in one setting with an Ahmed glaucoma valve implantation and scleral fixation (SF) of an aniridic intraocular lens (IOL). The patient remains in follow-up and has achieved good intraocular pressure control with the Dorzox-Timolol combination and a vision of 6/60.