Study Details Most Common Ocular Complications from Electrical Trauma

While electrical and lightning injuries are uncommon, comprising just 4% of all trauma incidents, they pose a considerable threat to the eye. Researchers recently conducted a comprehensive systematic review examining the ophthalmological manifestations, visual outcomes and treatment strategies in patients who suffered from electrical and lightning-related trauma. They observed that these patients experienced a wide array of ocular complications, from cataracts to retinal detachments, the frequency of which varied based on the voltage of exposure and resulting visual impairment. In a systematic review involving patients aged two to 78 who suffered electric or lightning injuries, visual outcomes reported for 56 individuals revealed that more than half suffered visual impairment, and those who did had a greater risk of developing cataracts and macular cysts. Photo: Piedrahita MA, et al. Graefe's Arch Clin Exp Ophthalmol. 2025;13:1-10. Click image to enlarge.The systematic review involved an extensive search of databases including PubMed, Cochrane Library and Web of Science, yielding a total of 45 relevant studies conducted over the past two decades. These studies included 183 participants ranging from children to adults aged two to 78 years who experienced electrical and lightning injuries.Cataracts emerged as the most prevalent anterior segment issue, affecting 30.1% of the participants. Other reported complications involving the front of the eye included superficial punctate keratitis (12.0%), anterior uveitis (9.3%), corneal edema (6.6%) and conjunctivitis (5.5%).The study authors noted in their paper that previous literature has also identified cataracts as the most common anterior segment complication resulting from electrical and lightning injuries, with the exception of one study that found punctate corneal epithelial erosions to be the top complication. They also pointed out that “the onset of cataracts following electrical trauma varies widely, ranging from immediate post-injury development to several years later,” highlighting the need for continued monitoring.As for the posterior segment, macular cysts were the most frequently reported, occurring in 10.4% of cases, followed by macular holes at 8.7% and retinal pigment epithelium disruption at 7.7%. Other complications included retinal detachment, retinal atrophy and macular edema, each affecting 4.4% of patients, while posterior vitreous detachment and retinal hemorrhage were present in 3.3% of cases.In prior studies, macular holes and optic neuritis were identified as the most commonly reported posterior complications of electrical trauma, rather than macular cysts as this investigation found, with macular holes as the runner-up. “The frequent involvement of the macula may be explained by its high concentration of melanin compared to other ocular tissues, which increases electrical resistance and reduces heat dissipation,” the authors explained in their paper.Visual outcomes assessed for 56 patients revealed that 51.4% experienced some level of visual impairment, with 33.9% classified as legally blind. The level of visual impairment appeared to impact the risk of developing ocular complications from electrical or lightning injuries: among patients categorized as legally blind, cataracts were more frequently observed (73.7%) compared to 61.3% of patients with only some visual impairment and 56.0% of those with no impairment. Similarly, macular cysts were more common among legally blind patients (26.3% vs. 12.0% of those with no visual impairment). High-voltage exposure was also linked to a significantly increased incidence of cataracts (82.4% vs. 37.5% for low-voltage injuries) and macular cysts (11.8% vs. 0%). “Based on our findings,” the study authors suggested, “while all patients require thorough ophthalmological evaluation, those exposed to high-voltage injuries or presenting with significant visual impairment should undergo more intensive assessment and follow-up.”Looking at treatment approaches, nearly one in four patients underwent a surgical procedure, including phacoemulsification (15.9%) and vitrectomy (6.0%). Less commonly performed procedures included evisceration, iridotomy, trabeculectomy, scleral buckle and membrane peeling. Specific data on the effectiveness of these interventions in patients who suffer electrical trauma is lacking, which the authors suggest could be a focus of future research.In summary, the authors note, “These findings emphasize the importance of thorough ophthalmological evaluation and follow-up in patients exposed to electrical trauma to mitigate long-term visual deficits.”Click here for the journal source. Piedrahita MA, Pineda-Vanegas AF, Moreno-Mendoza F, et al. Ophthalmological manifestations, visual outcomes, and treatment of electrical and lightning trauma: a systematic review. Graefe's Arch Clin Exp Ophthalmol. 2025;13:1-10.