Traumatic Anterior Crystalline Lens Dislocation with Pupillary Block
Section outline
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A patient presented with acute pain and decreased vision in the left eye after sustaining a direct high-pressure water jet (pressure washer) injury. Examination revealed anterior prolapse of the crystalline lens into the anterior chamber with corneal edema and elevated intraocular pressure (IOP) of 60 mm Hg, consistent with secondary acute angle-closure glaucoma from pupillary block. After failure of maximal medical IOP-lowering therapy, emergent in-office lens repositioning was performed, in which the patient was positioned supine and gentle pressure was applied with a cotton swab on the peripheral cornea to guide the lens posteriorly, followed by miotic administration. This maneuver successfully reduced IOP from 60 to 17 mmHg the next day and served as a bridge to definitive surgery. One day later, the patient underwent pars plana vitrectomy and pars plana lensectomy. This case illustrates the unique mechanism of pressure washer ocular injuries — high-velocity hydraulic force causing zonular disruption and anterior lens dislocation without globe rupture — and highlights the role of in-office lens repositioning as a rapid, non-surgical temporizing intervention for anterior lens dislocation with secondary angle closure, followed by staged definitive surgical management.
Presentation Date: 05/21/2026
Issue Date: 05/22/2026
