Electrical and lightning injuries may be rare, but when they do occur the eyes are frequently in the line of fire. A recent systematic review analyzed 71 studies encompassing 183 patients with electrical or lightning-related ocular trauma, revealing patterns that should be on every ophthalmologist’s radar.
The standout finding? Cataracts. Present in 30 percent of cases, they were by far the most common anterior segment complication – particularly in patients exposed to high-voltage injuries (82 percent vs. 38 percent in low-voltage cases). The cataracts took various forms – posterior and anterior subcapsular types led the pack. Interestingly, many cases of cataract formation were associated with cranial entry points, and their onset could be delayed by months or even years, highlighting the need for long-term follow-up.
Posterior segment damage wasn’t far behind, with macular cysts, macular holes, and RPE disruption topping the list. These were more likely in high-voltage cases and strongly associated with visual impairment. In fact, over half of the patients with available visual outcome data had some degree of impairment, and 34 percent met the criteria for legal blindness.
The treatment for this type of damage varied. Topical corticosteroids and cycloplegics were frequently used, but surgical intervention was often necessary – most commonly phacoemulsification (16 percent) and vitrectomy (6 percent). Patients undergoing these procedures often achieved better visual outcomes, although data specific to electrical trauma remains sparse.
The take-home message for ophthalmologists? A high index of suspicion is warranted in any patient with a history of electrical or lightning trauma, even if they’re asymptomatic at presentation. High-voltage exposure, cranial contact points, and delayed symptom onset should all prompt comprehensive and ongoing ocular evaluation.
As the study underscores, even a single electric jolt can trigger a cascade of serious and sight-threatening ocular complications, and so timely diagnosis and intervention may make all the difference in preserving vision.
Teaser image credit: Original images sourced from Adobestock.com
