Electrical injury is not uncommon as many people, come into contact with electricity on daily basis. However only few cases of electrical cataract have been reported because not many patients survive after a high electric voltage , needed to induce cataract .Most of the cases of electric injury have no visual complaints early, but their visual acuity decreases after a few months with development of cataract.
Till now as an eye specialist I have come across some cases of electrical cataract. Three patients ( labourers) had electrical injury while at work , while the other three had high voltage wires falling on them while walking on the street. In this part of the world electricity runs via overhead wires which were not insulated, increasing the chances of such electrical injury. All these patients were under 40 years of age. During an electric shock, the current flows through the body between 2 contact points. The clinical picture of electrical injury is influenced by numerous factors including voltage, tissue sensitivity, type of current (direct or alternating), length of contact, place and area of contact, and route traveled in the body. The cataracts formed were soft but total cataracts which could be easily aspirated providing good visual gain. All the patients had an entry and exit wound. Exit wound on the body of a person is a crucial sign of electric current and can be the only external evidence of fatal electric current injury. One of the patients required an amputation of his hand while another had total loss of his ear lobe at the exit wound.
Electrical cataracts causing bilateral blindness at a young age is of great concern, as what we may be seeing is only part of a much bigger problem that needs to be tackled at its roots. Our apprehension lies in that such injuries are totally avoidable if an extra amount of care is taken while working at such high voltage currents and secondly the overhead wires which are uninsulated should be properly insulated.
Electrical insults to the human body range from death to damage to various parts of the body. An incidence of 6.2% of cataracts is reported following electric injury5.
It can result in a wide range of ocular injuries with resultant ocular complications. Bobby and Kikkawa describe a patient post electrical injury with bilateral cataracts and optic atrophy with widespread macular pigment disruption who later developed retinal detachment causing significant permanent visual impairment . While none of our patients had retinal complications, one needs to follow up these cases over long term due to the potential to cause retinal detachments later on.
Proper education , insulation where ever possible and wearing of safety gadgets should be encouraged. Handling of high volt electric wires should be done by professionally sound personal.
For the state of Jammu and Kashmir which harbors one of the highest rates of blindness in India and is riddled with social conflict, awareness and efforts need to be harnessed to prevent this public health issue. What we observed could probably just be the tip of the iceberg.
Dr Rayees Ahmad is Ophthalmologist at District Hospital, Ganderbal