 Lightning strikes the earth more than 100 times each

second and 8 million times per day

 Electrocution or electrofulguration: most frequent

cause of injuries by natural phenomena; with high
mortality (20-30%) and morbidity (75%)

 Asystolic cardiac arrest or ventricular fibrillations

 Lightning is an uncommon cause of ocular injury

 The power of lightning is 10,000 to 2,00,000 amperes and a

voltage of 20 million to 1 billion volts

 Lightning exposure time is only 1 to 100 milliseconds,

taking less time to cause damage of tissue

 Tissue destruction is caused by both thermal effect and

electrolysis
 Worldwide, approximately 50,000 thunderstorms occur per
day leading to forest fires, injury to animals and people,
damage to electrical and communications lines and
electronics

 A 5-year figure maintained by the National Emergency

Operation Centre under the MOHA shows that as many
as 553 persons were killed and 1,132 other injured by
lightning strikes during the period

 Worldwide total annual fatalities to be about 24,000 and

annual injuries are estimated to be about 240,000 for the
tropical and subtropical areas of the world
 Lightning may reach its victims by any of the four routes
and causes injuries:

1. Direct strike: when the major current flows directly

through the victim and is facilitated by metal objects

2. Splash: where lightning strikes an object first and then arcs

through the path of least resistance

3. Contact: the bolt strikes an object the victim is in contact

with i.e. electrocution while telephonic conversation

4. Ground current: here the lightning travels along the

surface towards the victim after striking the ground
Ocular injuries :
 thermal keratopathy
 Uveitis
 hyphaema
 anterior and posterior subcapsular cataract
 lens dislocation
 vitreous hemorrhage
 retinal edema and haemorrhage
 retinal detachment
 vascular occlusion
 choriodal rupture
 cystoid macular edema and macular hole
 Cataract is the most frequent intraocular complication of
lightning(Tribble et al. 1985), anterior and posterior
subcapsular type (Duke-Elder 1972)

 Our patient probably sustained the injury by the splash

mechanism mentioned; lightning passed through the
nearby object and through the ground

 After the incident patient complained of poor vision ,pain

and redness of both eye
 Lightning induced cataract may be attributed to:

 decreased permeability of lens capsule

 protein coagulation by electrical current

 nutritional impairment of lens due to iritis and mechanical

damage to the lens fibers

 In the iris and ciliary body, inflammatory changes occurred

frequently leading to uveitis
 Usually uveitis has been associated with cataracts—
suggesting that lens capsule disruption leads to the
release of angiogenic substances

 The macula is very sensitive to thermal damage because

of the high melanin content of the retinal pigment
epithelium (RPE)

 In our case there was BE CATARACT with UVEITIS

 Patient was treated with oral and topical corticosteroid
and cycloplegics in both the eyes

 Pateint’s vision improved from 5/60 to 6/36 in both eyes

 At subsequent follow up cataract surgery will be done in

both eyes
CASE 1:Pak J Ophthalmol 2014

 case of lightning injury in a 30 year old female who

presented one month after the injury. Her BCVA was 6/24 in
RE and 6/60 in left eye LE

 Slit lamp biomicroscopy revealed bilateral uveitis and

sphincter tear in left eye, lightning induced cataract in both
eye and macular hole in left eye

 Optical Coherence Tomography revealed macular cyst in RE

and a full thickness macular hole (FTMH) in left eye
 Patient was treated with topical corticosteroid and
cycloplegics in both the eyes

 At subsequent follow up cataract surgery was done in

both eyes

 Post op BCVA at 1 month was 6/9 and 6/12 in right and

left eye

 There was a spontaneous resolution of the macular

lesion in both eyes
CASE 2: Department of Ophthalmology, Jawaharlal Institute
of Postgraduate Medical Education and Research
Pondicherry – India: 2006

 A 30-year-old healthy man was struck by lighting on the

scalp while he was walking on a street. He sustained a
second degree burn on the scalp

 The patient was unconscious for 2 days, during which he

was hospitalized in the emergency department

 Physical examination & ophthalmic examination were

unremarkable other than entry wound and exit wound

 All investigations were normal

 Four years later, the patient presented to opd with rapidly
decreasing vision over the previous 3 months

 Vision in both eyes had dropped to 20/400

 Slit lamp examination after full dilatation revealed dense

anterior subcapsular and posterior subcapsular cataract

 Phacoemulsification with posterior chamber intraocular

lens implantation was performed for both eyes

 Fundus examination revealed bilateral posterior vitreous

detachment and normal macula with no evidence of any
peripheral retinal break
 Lightening induced ocular morbidity can be prevented
through timely diagnosis and proper management.