Pseudophacocele

Pseudophacocele means that an artificial lens implant (an intraocular lens, or IOL) that was put inside the eye during cataract surgery has been pushed out of the eye’s inner chamber and ended up under the conjunctiva (the thin, clear skin over the white of the eye). Think of it as the man-made lens slipping through a split or weak spot in the white wall of the eye (sclera) and getting stuck just beneath the surface covering. Doctors call this “subconjunctival dislocation” of the IOL. It almost always happens after blunt injury to an eye that previously had cataract surgery, especially if an old surgical wound gives way. EyeWikiAAOPMC+1

“Pseudophacocele” is a rare eye emergency that happens in people who have had cataract surgery and now have an artificial lens (an intraocular lens, or IOL). After a strong blunt hit to the eye, the tiny fibers that hold the lens in place can tear, and a crack can open in the white wall of the eye (the sclera). The IOL can then slip out through that crack and get stuck just under the clear skin that covers the white of the eye (the conjunctiva). When the natural lens does this, doctors call it a phacocele; when an artificial lens does it, it’s called a pseudophacocele. Both are uncommon, but pseudophacocele is especially rare and always needs urgent hospital care to prevent infection inside the eye and permanent vision loss. EyeWikiPMC+1

This condition is “pseudo-phaco-cele” because it resembles a classic phacocele, where the natural crystalline lens herniates into the subconjunctival space after trauma. In pseudophacocele it’s the artificial lens that herniates, not the natural one. The mechanism is the same: severe blunt force compresses the eye, breaks the zonules that hold the lens, and ruptures or reopens a scleral wound, creating a path of least resistance for the lens to escape into the subconjunctival pocket. EyeWikiPMC+1

Pathophysiology

A strong hit to the eye suddenly increases pressure inside the eyeball. The globe briefly changes shape (like squeezing a water balloon). If the eye ever had a cataract incision, that old tunnel or scar can split open (dehiscence). The IOL, sometimes still inside the capsular bag, can be forced through that gap, pushed under the conjunctiva, and then lodges there. The conjunctiva often stretches without tearing, so you may not see an open hole at the surface, just a bulge under the white of the eye. Sometimes the lens even migrates into deeper planes like the suprachoroidal space (extremely rare), but most cases are subconjunctival. ijooo.org

A characteristic bedside clue is the “golden half-ring sign”—a bright, curved glint seen through the conjunctiva that outlines part of the displaced IOL. PMC

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Types of pseudophacocele

Because the medical literature is mostly case reports, there isn’t a single universal classification. Clinically, doctors describe types by where the IOL ends up, how it moved, and what structure failed. The following “types” help you understand the patterns you’ll read about in reports.

1. By location under the conjunctiva

• Superior / inferior / nasal / temporal subconjunctival pseudophacocele. The IOL sits under a specific quadrant of conjunctiva; inferior and superonasal have been reported after blunt trauma. You see a localized, firm, sometimes shiny bulge in that quadrant. PMC+1

2. By depth of displacement

• Subconjunctival (most common). IOL lies just under conjunctiva/Tenon’s fascia.

• Suprachoroidal / sub-choroidal (exceptionally rare). The IOL slips through a scleral rent into the potential space between sclera and choroid. This is unusual but documented. ijooo.org

3. By timing after cataract surgery

• Early (days–weeks after surgery): occurs when a fresh wound is unstable.

• Delayed (months–years later): the old wound reopens with trauma; many cases occur years after uneventful surgery. LippincottPMC

4. By IOL position and hardware

• In-the-bag pseudophacocele: the IOL and capsular bag migrate together.

• Out-of-the-bag pseudophacocele: the IOL moves without the bag (e.g., haptic through a rent).

5. By wound pathway

• Through prior cataract incision (scleral tunnel or corneoscleral incision) — the most typical route.

• Through a new scleral rupture created by the impact. EyeWiki

6. By associated ocular damage

• With open-globe injury signs (positive Seidel, hypotony, uveal prolapse).

• Without obvious surface leak (conjunctiva intact; the IOL sits under a stretched conjunctiva). NCBIMedscape

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Causes and contributors

In real life, blunt trauma is the main driver. The items below expand the typical contexts and risk enhancers documented in reports and reviews.

1. Blunt eye trauma (general). The core cause; the eye compresses, the wound gives way, and the IOL is pushed outward. EyeWikiAAO

2. Falls in older adults. A common real-world scenario; elderly eyes often have prior cataract wounds and stiffer sclera. Lippincott

3. Assaults or fist injuries. Sudden, direct blows produce the pressure spike that opens old wounds. ResearchGate

4. Sports impacts (ball or elbow). Rapid hit to the globe can recreate the “squeeze” that drives the IOL outward. PMC

5. Road-traffic accidents. Airbags/steering-wheel impacts can cause open-globe rupture with IOL extrusion. NCBI

6. Old cataract incision dehiscence. A previous scleral tunnel may split open years later when stressed. ijooo.org

7. Poor wound construction or inadequate suturing (historical techniques). Older large-incision extracapsular surgeries leave longer scars vulnerable to reopening. ijooo.org

8. Zonular weakness (pseudoexfoliation, prior trauma). Weak zonules let the lens complex move during impact, aiding extrusion. EyeWiki

9. High myopia (longer, thinner sclera). Biomechanically more vulnerable to deformation and rupture under impact. (Inference consistent with open-globe risks.) PMC

10. Connective-tissue disorders (e.g., Marfan, Ehlers–Danlos): weaker supporting tissues predispose to lens/IOL displacement when the eye is hit. (By analogy with phacocele risk.) Lippincott

11. Scleritis or scleral thinning. A thin or inflamed sclera can tear more easily during trauma. Lippincott

12. Prior glaucoma filtering surgery (blebs can represent weak points). Blunt force may tear the site and create an exit path. (Mechanistic inference within OGI patterns.) AAO

13. Large, rigid posterior chamber IOL geometry. A rigid optic/haptic can act like a wedge during a sudden squeeze. (Mechanistic inference supported by case descriptions.) Lippincott

14. Capsular bag compromise (e.g., capsulotomy defects). Facilitates out-of-bag implant mobility under stress. EyeWiki

15. Eye rubbing or Valsalva soon after surgery. In the early postoperative period, stress can worsen an unstable wound if a blow occurs. (General postoperative risk principle.) AAO

16. Occupational hits (tools, machinery). Reported mechanisms mirror sports impacts. PMC

17. Animal-related blunt injury (e.g., bull horn): classic case with golden half-ring sign. PMC

18. Household accidents (doors, furniture corners). Low-velocity blunt impacts can still reopen old wounds. PMC

19. Periocular surgeries or injections with inadvertent pressure on a vulnerable area (uncommon). Theoretically can precipitate dehiscence in scarred sclera. (Mechanistic extrapolation within OGI.) AAO

20. Idiopathic in fragile eyes (very rare). Occasionally no clear trigger is recalled, but the biomechanical setting (old scar + thin sclera) makes the eye susceptible; a minor bump suffices. (Pattern consistent with delayed OGI presentations.) PMC

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Symptoms and signs

1. Sudden drop in vision in the injured eye (blur to counting fingers). The optical path is disrupted and other trauma may co-exist. Lippincott

2. Eye pain—from tissue tears, inflammation, or high/low pressure. NCBI

3. Redness (subconjunctival hemorrhage, chemosis) over the bulging area. PMC

4. A visible “lump” under the white of the eye—a firm, localized bulge; sometimes shiny if the IOL optic shows through (golden half-ring sign). PMC

5. Foreign-body sensation and tearing due to surface irritation. Lippincott

6. Photophobia (light sensitivity) from anterior segment inflammation. EyeWiki

7. Irregular or dilated pupil (traumatic mydriasis, sphincter tears). EyeWiki

8. Hyphema (blood in the front chamber) after blunt trauma. EyeWiki

9. Low eye pressure (hypotony) if there is a leak/open globe. NCBI

10. Positive Seidel test (if performed appropriately): fluorescent dye shows aqueous leakage—used cautiously and not if rupture is obvious. NCBIMedscape

11. Distorted cornea at the wound or local edema from impact. AAO

12. Vitreous hemorrhage or floaters if posterior segment is involved. (Common in severe blunt trauma.) PMC

13. Double vision or reduced visual field if ocular alignment or retina is affected. (Trauma-related.) PMC

14. Headache or periocular swelling from associated facial injury. NCBI

15. Signs of endophthalmitis (rare early complication if an open route allowed microbes): pain, redness, decreased vision, hypopyon—requires urgent care. (General OGI principle.) AAO

Safety note: If an open-globe injury is suspected, avoid any maneuver that presses the eye (e.g., routine tonometry or scleral depression) until a surgeon has assessed and protected the globe. NCBI

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Diagnostic tests

A) Physical exam

1. Focused trauma history + prior eye surgery review. Ask about the exact blunt event and cataract surgery details (incision type, date). This uncovers the typical mechanism (old wound + hit). ijooo.org

2. Visual acuity testing (each eye). Establishes baseline and urgency; severe reduction suggests extensive injury. AAO

3. Pupil exam, including RAPD check (swinging-flashlight test). Finds optic-nerve/retinal compromise after trauma. PMC

4. External inspection and lid eversion. Looks for a localized subconjunctival bulge housing the IOL, hidden lacerations, or foreign bodies; lid eversion can reveal concealed lesions. PMC

5. Slit-lamp biomicroscopy (gentle, with shield if rupture suspected). Documents conjunctival swelling, wound gape, uveal tissue, hyphema, and clues of IOL under conjunctiva (shiny edge). AAO

6. Dilated fundus exam (only if globe integrity is secured). Evaluates retinal tears/detachment or hemorrhage that often accompany significant blunt trauma. EyeWiki

B) Manual bedside tests

7. Seidel test (fluorescein leak test)—only when rupture isn’t obvious. Shows a waterfall-like dark stream diluting green dye under cobalt-blue light, indicating an active leak. Avoid if an open globe is clear or suspected. NCBImorancore.utah.eduMedscape

8. Confrontation visual fields. A quick screen for field loss that could reflect retinal/optic-nerve injury after trauma. StatPearls

9. Color vision (Ishihara) and contrast sensitivity. Early, subtle optic-nerve or macular dysfunction can appear here even when acuity is decent. StatPearls

10. Ocular motility and alignment checks. Blunt trauma can cause diplopia or muscle entrapment; documenting this frames surgical planning and prognosis. AAO

Caution: Tonometry (pressure measurement) and scleral depression are deferred until the surgeon rules out an open globe. NCBI

C) Laboratory & pathological tests

11. CBC and basic metabolic panel (pre-op readiness). Supports safe anesthesia/surgery and can flag anemia or systemic issues after trauma. (Common OGI perioperative practice.) AAO

12. Coagulation profile (if there’s bleeding or planned surgery). Helps anticipate intraoperative bleeding risk. (OGI surgical planning principle.) AAO

13. Aqueous/vitreous sample for Gram stain and culture (when endophthalmitis is suspected). Confirms infection and guides antibiotics. (Standard ocular infection workup.) AAO

14. Explanted material/capsular tissue histopathology (if removed). Occasionally analyzed to document capsular pathology or chronic inflammation around the implant, especially in complex cases. (Pathology practice in complex IOL cases.) AAO

D) Electrodiagnostic tests

15. Visual Evoked Potential (VEP). Helps judge optic-nerve function after trauma when media are hazy or the exam is limited; flash VEP can inform prognosis in traumatic optic neuropathy. PMC

16. Electroretinography (ERG; full-field or pattern/multifocal as needed). Objectively measures retinal function and distinguishes retinal vs. optic-nerve dysfunction, especially useful when the fundus view is blocked by hemorrhage or edema. NCBICenters for Medicare & Medicaid Services

E) Imaging tests

17. Anterior-segment OCT (AS-OCT). Non-contact cross-section images of cornea-sclera; helps identify wound dehiscence, fluid tracts, and the anterior edge of an IOL if visible. Useful when the eye is fragile. AAOEyeWiki

18. Ultrasound biomicroscopy (UBM). High-frequency ultrasound that sees behind the iris and through cloudy corneas; excellent for localizing an IOL, assessing zonules/ciliary body, and mapping anterior scleral tears. PMCoftalmoloji.org

19. B-scan ultrasonography (posterior segment). When the view is blocked, B-scan shows retinal detachment, vitreous hemorrhage, and may suggest the position of lens/IOL if not too anterior. EyeWiki

20. CT scan of the orbits (thin cuts). A robust way to assess open-globe signs, scleral rupture, intraocular foreign bodies, and the location of displaced hardware when ultrasound is limited or dangerous. AJR Onlin

Non-pharmacological treatments

Below are supportive non-drug steps used before and after surgery. In the pre-hospital and emergency phase, the key goal is to protect the open eye and get surgical repair quickly. After the eye is closed and stable, additional measures help comfort and healing. Where timing matters, I note “only after globe closure”.

1. Rigid eye shield (not a patch)
   Purpose: Protects the eye from further pressure or accidental touch.
   Mechanism: Forms a hard dome so nothing presses on the eyeball. Pre-hospital must. Never use a pressure patch because pressure can force tissue or germs in further.

2. Head elevation and strict “no Valsalva”
   Purpose: Lowers eye venous pressure and reduces the chance of more tissue extrusion.
   Mechanism: Elevating the head 30–45° and avoiding coughing, straining, nose-blowing, or bending keeps pressure inside the eye lower.

3. NPO (nothing by mouth) and anti-nausea strategy
   Purpose: Prepares for urgent anesthesia; prevents vomiting that spikes eye pressure.
   Mechanism: Empty stomach for safe surgery; avoiding vomiting reduces sudden pressure surges.

4. Eye rest and activity restriction
   Purpose: Prevents bumps and spikes in eye pressure.
   Mechanism: Quiet, low-movement environment until surgery and during early healing.

5. Protective transport positioning
   Purpose: Keeps the injured side up and avoids pressure.
   Mechanism: Reduces blood pooling and mechanical stress during transfer.

6. Clean cover and gentle surface care only if advised
   Purpose: Limits contamination of an open globe.
   Mechanism: If debris is present, clinicians may very gently manage the surface; patients should not rinse or rub the eye themselves.

7. Cold compress for swelling (only if globe is confirmed closed)
   Purpose: Reduces lid swelling and discomfort.
   Mechanism: Vasoconstriction at the eyelids reduces edema; never press on the eyeball.

8. Photophobia control
   Purpose: Comfort in bright light sensitivity.
   Mechanism: Sunglasses and dim lighting reduce ciliary spasm discomfort.

9. Sleep hygiene with safe positioning
   Purpose: Prevents nighttime rubbing or pressure.
   Mechanism: Shield stays on during sleep; avoid sleeping on the injured side.

10. Bowel regimen (non-drug options first)
    Purpose: Prevents straining on the toilet.
    Mechanism: High-fiber foods and fluids (if allowed) lower constipation risk; drug stool softeners can be added if needed.

11. Falls-risk reduction
    Purpose: Prevents another blow while vision is blurred.
    Mechanism: Home safety check, good lighting, non-slip shoes, mobility assistance.

12. Protective eyewear for the fellow eye
    Purpose: Safeguards the other eye and the healing eye later.
    Mechanism: Polycarbonate safety glasses during daily tasks and sport once cleared.

13. Wound-care education
    Purpose: Keeps the surgical site clean and reduces infection risk.
    Mechanism: Hand hygiene, drop-instillation technique, and shield use as instructed.

14. Return-warning education (“safety-netting”)
    Purpose: Fast action if complications arise.
    Mechanism: Teach signs of infection or pressure rise (more pain, redness, drop in vision, pus, fever) and to seek urgent care.

15. Smoking cessation support
    Purpose: Better wound healing.
    Mechanism: Stopping tobacco improves oxygen delivery and collagen synthesis.

16. Nutrition for tissue repair
    Purpose: Supplies building blocks for sclera and conjunctiva healing.
    Mechanism: Adequate protein, vitamin C, zinc, and fluids support collagen and immune function (details in the diet section).

17. UV protection outdoors (after closure)
    Purpose: Comfort and reduces phototoxic stress.
    Mechanism: UV-blocking sunglasses and brimmed hats.

18. Dry-eye surface care (after closure, if advised)
    Purpose: Comfort and epithelial health.
    Mechanism: Preservative-free lubricants reduce friction over healing tissues.

19. Adherence planning
    Purpose: Ensures drops and visits are not missed.
    Mechanism: Written schedule, alarms, caregiver help.

20. Psychological support
    Purpose: Trauma can be scary; anxiety harms sleep and adherence.
    Mechanism: Short counseling and reassurance improve coping.

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Drug treatments

Doses below are typical adult starting points in emergency ophthalmic care; your eye surgeon will tailor them to you, your kidney function, allergies, and local protocols. Do not self-medicate. Pseudophacocele is managed as an open-globe injury with very high infection risk. Lippincott

1. Intravenous (IV) vancomycin (glycopeptide antibiotic)
   Dose & timing: Often ~15 mg/kg IV every 12 hours; first dose in the ER.
   Purpose: Covers Gram-positive organisms (including MRSA) in open-globe prophylaxis.
   Mechanism: Blocks bacterial cell wall synthesis.
   Common side effects: Red man syndrome (with rapid infusion), kidney strain, rare hearing effects.

2. IV ceftazidime (third-generation cephalosporin)
   Dose & timing: 2 g IV every 8 hours given with vancomycin.
   Purpose: Covers Gram-negative organisms (including Pseudomonas).
   Mechanism: Cell wall inhibition.
   Common side effects: Allergy, diarrhea; rare liver/kidney effects.

3. Topical moxifloxacin 0.5% (fluoroquinolone)
   Dose & timing: 1 drop every 1–2 hours while awake, then taper after closure.
   Purpose: High corneal/conjunctival antibiotic levels to reduce surface bioburden.
   Mechanism: DNA gyrase/topoisomerase inhibition.
   Side effects: Stinging, bitter taste; rare allergy.

4. Cycloplegic: atropine 1% drops
   Dose & timing: 1 drop twice daily after the globe is closed unless otherwise directed.
   Purpose: Relieves ciliary spasm and pain; stabilizes the iris.
   Mechanism: Muscarinic blockade causing ciliary muscle and sphincter relaxation.
   Side effects: Light sensitivity, blurred near vision; rare systemic effects (dry mouth, confusion).

5. Topical corticosteroid: prednisolone acetate 1%
   Dose & timing: Typically 1 drop 4–8×/day after surgical closure and per surgeon.
   Purpose: Controls inflammation that can harm vision.
   Mechanism: Suppresses inflammatory cytokines.
   Side effects: Steroid response rise in eye pressure, delayed epithelial healing, infection risk; used only when safe.

6. Systemic anti-nausea: ondansetron
   Dose & timing: 4–8 mg IV/PO every 8 hours as needed.
   Purpose: Prevents vomiting that spikes eye pressure.
   Mechanism: 5-HT3 receptor blockade in the brainstem.
   Side effects: Headache, constipation; rare QT prolongation.

7. Pain control: acetaminophen (paracetamol)
   Dose & timing: 500–1000 mg PO every 6–8 hours (max 3–4 g/day).
   Purpose: Analgesia without blood-thinning effect.
   Mechanism: Central COX modulation.
   Side effects: Liver toxicity if overdosed or with heavy alcohol use.

8. Tetanus toxoid (vaccine) ± tetanus immune globulin
   Dose & timing: 0.5 mL IM vaccine; immune globulin if status unknown/dirty wound.
   Purpose: Prevents tetanus after open injury.
   Mechanism: Induces protective antibodies; immune globulin provides immediate passive antibodies.
   Side effects: Soreness, low-grade fever.

9. IOP-lowering agents (as indicated): topical timolol 0.5% or oral acetazolamide
   Dose & timing: Timolol 1 drop twice daily; acetazolamide 250–500 mg PO/IV.
   Purpose: Treats pressure spikes that threaten optic nerve perfusion (if surgeon approves).
   Mechanism: Timolol reduces aqueous production (β-blocker); acetazolamide inhibits carbonic anhydrase.
   Side effects: Timolol: bradycardia, bronchospasm; acetazolamide: tingling, diuresis, kidney stones, sulfa allergy.

10. Intravitreal antibiotics during surgery (surgeon-administered)
    Dose & timing: Vancomycin and ceftazidime injected in the eye if endophthalmitis risk is high.
    Purpose: Direct sterilization of the vitreous cavity.
    Mechanism: High intraocular concentrations bypass blood-ocular barriers.
    Side effects: Rare retinal toxicity; handled by the vitreoretinal surgeon.

Rationale for aggressive antibiotic coverage and emergency management is drawn from case series and reviews describing pseudophacocele and open-globe risks, particularly the risk of endophthalmitis and poor outcomes without rapid repair. PMCLippincott

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Dietary molecular supplements

Supplements are adjuncts, not treatments. Always clear them with your surgeon to avoid drug interactions or bleeding risks around surgery.

1. Vitamin C (ascorbic acid) 500–1000 mg/day
   Supports collagen cross-linking and immune function; vitamin C is a co-factor for proline/lysine hydroxylation in collagen, aiding wound strength.

2. Zinc 15–25 mg elemental/day
   Used by enzymes in DNA/protein synthesis; supports epithelial repair and immunity.

3. Vitamin A (as beta-carotene or modest retinol 2500–5000 IU/day)
   Important for epithelial surfaces and immune health; precursor to retinoic acid which regulates gene expression in healing.

4. Lutein + Zeaxanthin (10 mg + 2 mg/day)
   Macular antioxidants; reduce oxidative stress in ocular tissues; often used long-term for retinal health.

5. Omega-3 fatty acids (EPA+DHA 1–2 g/day)
   Anti-inflammatory lipid mediators (resolvins/protectins) that may support surface comfort; pause before surgery if your surgeon is concerned about bleeding risk.

6. Vitamin E (100–200 IU/day)
   Lipid-phase antioxidant; partners with vitamin C to limit oxidative injury.

7. Copper (1–2 mg/day when using zinc)
   Prevents copper deficiency anemia and is a co-factor for lysyl oxidase in collagen cross-linking.

8. N-acetylcysteine (600 mg 1–2×/day)
   Antioxidant precursor to glutathione; may support surface comfort by reducing mucus viscosity.

9. Curcumin (turmeric extract providing 500–1000 mg curcuminoids/day)
   Modulates NF-κB pathways; anti-inflammatory adjunct; avoid around surgery if surgeon advises.

10. Resveratrol (100–250 mg/day)
    Polyphenol with antioxidant/anti-inflammatory signals; potential microvascular benefits.

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Regenerative-stem” therapies

There are no approved stem-cell drugs for pseudophacocele repair. The cornerstone is surgery plus antibiotics. Biologic adjuncts below may be considered by specialists for specific surface-healing problems (not for the dislocated IOL itself). Always use them only under a specialist and never at unregulated clinics.

1. Tetanus vaccination/immune globulin (approved immune protection)
   Dose: Vaccine 0.5 mL IM; immune globulin per protocol.
   Function/mechanism: Active and passive immunity against C. tetani toxins; essential after open injuries.

2. Autologous serum tears (AST) 20%–50% (specialist-prepared)
   Dose: 1 drop 4–8×/day for weeks as needed.
   Function: Supplies growth factors (EGF, fibronectin, vitamin A) present in your serum to help corneal epithelium heal.
   Mechanism: Mimics natural tears with trophic factors; used for persistent epithelial defects.

3. Platelet-rich plasma (PRP) eye drops (specialist-prepared)
   Dose: Protocols vary (e.g., 4–8×/day).
   Function: Platelet-derived growth factors (PDGF, TGF-β) may promote surface healing.
   Mechanism: Delivers concentrated growth factors from your own platelets.

4. Amniotic membrane graft or extract (surgical/biologic adjunct)
   Dose: Surgical placement or drops per specialist.
   Function: Provides a biological bandage rich in anti-inflammatory and anti-scarring factors.
   Mechanism: Matrix supports epithelial migration and reduces fibrosis; used for conjunctival/surface defects, not to treat the pseudophacocele itself.

5. Cenegermin (recombinant human nerve growth factor) 0.002%
   Dose: 1 drop six times daily for 8 weeks (approved for neurotrophic keratitis).
   Function: Helps corneal nerve/epithelium in select nerve-healing problems; off-label use is specialist-only.
   Mechanism: TrkA/p75NTR signaling to support corneal innervation.

6. Mesenchymal stem-cell–derived exosomes or stem-cell therapies (investigational)
   Dose: Research protocols only.
   Function/mechanism: Candidate biologics to modulate inflammation and repair; not approved for intraocular trauma. Avoid unregulated offers.

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Surgeries

1. Primary globe exploration and repair with removal of the extruded IOL
   What happens: Under anesthesia, the surgeon opens the conjunctiva, identifies and closes the scleral tear with fine sutures, gently removes the IOL lodged under the conjunctiva, and cleans any contaminated tissue.
   Why: Closing the eye wall and removing the misplaced lens restores eye integrity and lowers infection risk; this is the first-line, urgent operation. PMCLippincott

2. Anterior chamber washout and wound toilet
   What happens: Blood, inflammatory debris, and contaminants are irrigated from the front eye chamber.
   Why: Clears the visual axis and reduces infection/inflammation load.

3. Pars plana vitrectomy (PPV) if posterior segment is involved
   What happens: A vitreoretinal surgeon removes the vitreous gel, treats retinal tears, and can place intravitreal antibiotics.
   Why: Manages retinal detachment, vitreous hemorrhage, or suspected infection from the trauma. PMC

4. Secondary IOL implantation (delayed), method chosen to suit the eye
   What happens: After the eye heals, a new lens may be placed—options include scleral-fixated posterior chamber IOL, iris-claw lens, or an anterior chamber IOL.
   Why: Restores focusing power after the original IOL was removed; timing depends on inflammation and ocular stability. Case reports show IOL exchange can succeed in selected patients. Lippincott

5. Conjunctival reconstruction ± amniotic membrane or scleral patch
   What happens: Surgeons repair the conjunctiva and, if needed, overlay a biologic membrane or patch a large scleral defect.
   Why: Promotes surface healing, reduces scarring, and protects the repaired sclera.

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Prevention tips

1. Wear polycarbonate safety glasses during work, sports, yard work, or when near flying objects.

2. Follow post-cataract surgery restrictions strictly (no eye rubbing, no heavy lifting early on).

3. Keep floors clear, use night lights, and wear proper shoes to prevent falls.

4. Avoid high-risk contact sports unless your surgeon says it’s safe and you’re wearing protection.

5. Use seat belts; secure airbags and headrests properly.

6. Keep blood sugar and blood pressure controlled to reduce dizziness and fall risk.

7. Never rub the eye if it feels gritty—use sterile saline or tears and call your doctor.

8. Keep follow-up appointments after cataract surgery to spot wound problems early.

9. At work, follow safety protocols (guards, shields, signage).

10. Educate family/caregivers to place a rigid shield and seek help immediately after any eye trauma.

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When to see a doctor right away

• Any blunt hit to a pseudophakic eye (you have an IOL) with sudden vision drop, severe pain, bleeding in the eye, or a bulging, “bag-like” white lump under the conjunctiva.

• A peaked or misshapen pupil, new double vision, flashes/floaters, or a curtain over vision.

• After cataract surgery, any sudden redness, pus, fever, or increasing pain.
  These are emergencies because an open globe and endophthalmitis can steal sight quickly. Lippincott

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What to eat / what to avoid

1. Eat: Lean proteins (fish, eggs, legumes). Avoid: Skipping protein—collagen needs amino acids.

2. Eat: Citrus, berries, peppers (vitamin C). Avoid: Ultra-processed sweets that hinder healing.

3. Eat: Nuts/seeds in modest portions (vitamin E, zinc). Avoid: Excess salt that worsens swelling.

4. Eat: Leafy greens (lutein/zeaxanthin). Avoid: Smoking/vaping—these harm oxygen delivery.

5. Drink: Adequate water. Avoid: Dehydration (thicker tears, discomfort).

6. Eat: Whole grains and fiber. Avoid: Straining—fiber helps keep stools soft.

7. Consider (if surgeon approves): Omega-3-rich fish. Avoid: High-dose fish-oil capsules right before surgery if your surgeon advises, due to bleeding concerns.

8. Eat: Orange/yellow veggies (beta-carotene). Avoid: Excess vitamin A supplements without guidance.

9. Eat: Iron- and copper-containing foods (meats, legumes). Avoid: Unbalanced high-dose zinc without copper.

10. Eat: Balanced meals with modest caffeine. Avoid: Heavy alcohol, which dehydrates and can interact with pain meds.

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Frequently asked questions

1. Is pseudophacocele the same as phacocele?
   No. Phacocele is when the natural lens moves under the conjunctiva after trauma. Pseudophacocele is when the artificial intraocular lens does the same. Both are rare and dangerous. EyeWikiPMC

2. What causes it?
   Usually a blunt blow to an eye that previously had cataract surgery. The hit tears the support fibers and splits the sclera, letting the IOL herniate outward. PMC

3. How rare is it?
   Very rare. Even phacocele (with the natural lens) is uncommon among lens dislocations; pseudophacocele is rarer still, mostly described in small series and case reports. Lippincott+1

4. Why is it an emergency?
   Because the eye is effectively open, with high risk of endophthalmitis (severe internal infection) and other complications that can destroy vision. Lippincott

5. What are the symptoms?
   Sudden pain, big drop in vision, bloody eye, a bulging “bag” under the conjunctiva, misshapen pupil, light sensitivity, and sometimes floaters if the back of the eye is involved.

6. How do doctors confirm it?
   Eye examination often shows a subconjunctival “bag” containing the lens. If the cornea is too cloudy to see inside, ultrasound (B-scan) or CT may be used; but protection and urgent surgery take priority.

7. What is the first thing I should do after trauma?
   Place a rigid shield, do not press on the eye, and go to an emergency department with ophthalmology coverage. Do not eat or drink in case you need anesthesia.

8. What surgery will I need?
   Most people need globe repair to close the sclera and remove the displaced IOL. Some also need a vitrectomy if there are back-of-the-eye injuries. A new lens may be placed later. PMCLippincott

9. Can the original IOL be saved?
   Sometimes an IOL exchange or repositioning is possible, but often the extruded IOL is contaminated or damaged and must be removed; the new lens is placed later when the eye is quiet. Lippincott

10. Will I go blind?
    With fast surgical care and antibiotics, many people keep useful vision, but risk depends on how big the tear is, whether infection occurs, and if the retina is damaged. Early care improves odds. Lippincott

11. How soon is surgery done?
    As soon as safely possible—typically urgent or emergent once the diagnosis is made and you are cleared for anesthesia. Lippincott

12. How long is recovery?
    Weeks to months. Inflammation needs to settle; sutures and follow-up visits are common. A delayed IOL implant may be scheduled when stable.

13. What activities must I avoid?
    No rubbing, heavy lifting, bending, swimming, or dusty environments until your surgeon clears you. Keep the shield on as directed.

14. Can it happen again?
    The exact same event is unlikely once the eye is repaired and protected, but any eye can be injured by new trauma—so ongoing eye protection matters.

15. What about stem cells to fix it?
    There are no approved stem-cell drugs for this injury. Be cautious about clinics advertising cures. Standard care is surgery plus antibiotics; any regenerative therapy should be part of a regulated clinical study.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 21, 2025.