Ultrasonic Evaluation of Eyes With Blunt Trauma

Supervisors

Professor Doctor

Eman Mohamed El-HefnyProfessor of ophthalmology

Doctor

Maha Mohamed Othman Assistant Professor of ophthalmology

Doctor

Hossam Abo El-KhierLecturer of ophthalmology

Discussion committee

Professor DoctorAhmed Mostafa Ismail

Professor of OphthalmologyMansoura University

Professor Doctor

Eman Mohamed El-HefnyProfessor of ophthalmology

Professor DoctorMohamed Alsbaey Shahin

Professor of OphthalmologySuez Canal University

Introduction

If a small object hits the eye, itself may take most of the impact.

If a large object hits the eye most of the impact is usually taken bythe orbital margin.

Pathophysiology of Blunt Ocular Trauma

There are four main mechanisms:

1- Coup

2- Contrecoup

3- Equatorial expansion

4- Global repositioning

Location of Injury Anterior segment

Posterior segment

Adnexa

Orbit

Anterior Segment

Conjunctiva

Cornea

Iris & Ciliary body

Lens & Zonules

Effects on the Cornea

Blood stained cornea

Corneal Abrasion

Corneal Edema

Effects on the Iris and Ciliary Body

HyphemaAngle recessionIridodialysis

Traumatic mydriasis

Cyclodialysis Cleft

Effects on the Lens and Zonules

• Traumatic cataract

• Vossius' Ring

• Lens Subluxation

• Lens Dislocation

• Anterior Capsule Rupture

• Posterior Capsule Rupture

• PCIOL Dislocation

Posterior Segment

Vitreous

Retina

Choroid

Optic nerve

Effects on the Vitreous

Posterior vitreous detachment

• Vitreous hemorrhage

Effects on the Retina

Rhegmatogenous retinal detachment

• Commotio retinae

• Retinal Hge

• Retinal Tear without detachment

• Retinal Dialysis

Effect on the Optic Nerve

Optic nerve avulsion

Ultrasound

UBM

Orientations of the B-scan Probe

• Axial:Lesion in relation to lens &optic nerve .

•Transverse: Lateral extent, 6 clock hours .

•Longitudinal:AP extent,1 clock hour.

Examination Technique of UBM:

• Patients lying down in supine position

• Monitor at comfortable height

• Hand controller in an easily accessible position.

• Eye cup of suitable size separate the two lids, filled with methylcellulose 1.25% and saline.

Orientations of the UBM probe

• Transverse sectionLateral extent

• Radial section

Patients and MethodsThis study included 95 eyes of 95 patients representing 62% of all

patients with blunt ocular trauma attending the outpatient clinics

of Mansoura ophthalmic center during the period from October

2013 to October 2014.

History of penetrating ocular trauma or open globe injuries.

Chemical burns.

Completely normal eyes after examination by slit lamp,

US and UBM.

Exclusion criteria

For all patients, the following was done :

1) History taking

2) Ophthalmic examination:

Visual acuity assessment.

Slit lamp examination.

Fundus examination using non-contact volk 90 lens and

indirect ophthalmoscope if possible.

3) B-scan Ultrasonography: 4) UBM:

All eyes were examined by All eyes were examined by

HUMPHRY A/B scan system HUMPHRY Model 840.

Model 835.

For all patients, the following was done :

Age distribution of cases:

Type of traumatizing agents:

Visual Acuity among studied patients:

Findings by clinical examination:

Anterior Segment Posterior Segment

B-scan US findings:

UBM findings:

Comparison between clinical and ultrasonic findings:

B-scan Ultrasound and UBM detect structural changes which may be missed or can’t be detected by clinical examination especially with opaque media

Examples from our cases by

B-scan Ultrasound

Male patient of 44 years old was exposed to blunt trauma 2 years ago .. Clinical

examination show traumatic cataract

Case I

B-scan US show rupture of posterior capsule which cant be detected by clinical

examination

Vitreous Hemorrhage

Case II

Retinal Detachment

Case III

Posterior Vitreous Detachment Case IV

Retinal tear without detachment

Case V

Lens Dislocation

Case VI

PCIOL Dislocation

Case VII

Examples from our cases by

UBM

25 years old man exposed to blunt trauma .. Clinically slit lamp showed corneal oedema,

which mask visaulization of the anterior segment

Case I

UBM examination showed subluxated lens with vitreos prolapsed in AC.

Iridodialysis

Case II

Hyphema

Case III

Angle Recession

Case IV

Cyclodialysis Cleft Case V

PCIOL DislocationCase VI

Conclusions

Ultrasonography is a non invasive imaging modality which can provide reliable and detailed idea about ocular structures in patient with blunt ocular trauma .

When ophthalmoscopic evaluation is limited or not possible, echography is useful in evaluation and follow up of VH, CD and in the localization of retinal tear( with or without detachment).

High frequency ultrasound (Ultrasound Biomicroscopy) can provide a high resolution of the anterior segment of the eye (4mm x 4 mm).

UBM should be considered as a technique of choice in the evaluation of traumatic ocular pathologies and assessment of anterior chamber, its angle, iridociliaryunit and zonules.