OcuLearning › Trauma

Traumatic Cataract (Rosette Cataract)

URGENT — Trauma

Symptoms

History

  • Recent blunt or penetrating ocular trauma, or, less commonly, electrical injury/lightning strike.
  • Acute or subacute blurred vision following the injury.

Clinical Findings

Core findings

  • A feathery, star- or flower-shaped ("rosette") opacity radiating along the posterior lens sutures, classically appearing under the posterior capsule.
  • May appear immediately after blunt trauma or evolve over days to weeks.
  • Look for an associated Vossius ring — a circular imprint of iris pigment on the anterior lens capsule from the pupillary margin at the moment of impact — a marker of the same contusive mechanism.

Associated findings to actively rule out

  • Because the mechanism is trauma, always complete a full exam: hyphema, angle recession, lens subluxation/dislocation, retinal dialysis/detachment, commotio retinae, and, if penetrating, globe rupture or an intraocular foreign body.

Etiology

Mechanism

  • Blunt trauma causes a shockwave that disrupts the lens fiber architecture along its natural suture lines, producing the rosette pattern; a penetrating injury can directly breach the capsule.
  • Electrical injury/lightning: a distinct mechanism that produces anterior subcapsular opacities, sometimes with a similar stellate pattern.

Red Flags

Any traumatic cataract

  • Full dilated exam and globe-integrity assessment are mandatory — do not assume the cataract is the only injury.
  • Rule out occult open globe, especially with a penetrating mechanism.

Progressive/mature rosette

  • Lens capsule breach can release lens material into the anterior chamber, causing lens-induced (phacoanaphylactic or phacolytic) uveitis or secondary glaucoma — monitor for it.

Investigations

Clinical exam

  • Full anterior and dilated posterior segment exam, IOP check, and gonioscopy once safe, to assess for angle recession.
  • B-scan ultrasonography if the fundus view is obscured by the cataract or media opacity.

Imaging

  • CT orbit if an intraocular or intraorbital foreign body is suspected.

Treatment

Acute

  • Manage any concurrent injury first (hyphema, globe rupture, retinal pathology) per its own protocol.

Cataract itself

  • Observation if visually insignificant and stable.
  • Phacoemulsification (or, if the capsule is compromised, an alternate extraction technique) once the eye has quieted and refraction is stable, or urgently if lens material is inducing uveitis/secondary glaucoma.

Clinical Pearl

A rosette cataract is a flag, not a diagnosis — it tells you there was a real contusive force to the eye. Before getting absorbed in grading the lens, complete the trauma exam: angle, retina, and globe integrity.

Differential Diagnosis

  • Acquired age-related cataract
  • Vossius ring alone (without cataract)
  • Lens subluxation/dislocation
  • Phacolytic/phacoanaphylactic uveitis

Related Trauma Conditions