Us and UBM examination

UBM and US of Eye

Mohamed ELShafieAssistant lecturer of ophthalmology

Kafr ELShiekh university

Pathophysiology of Blunt Ocular Trauma

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

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

There are four main mechanisms:

1- Coup (injury at the same point)

2- Contrecoup (injury at the opposite point)

3- Equatorial expansion

4- Global repositioning

Mechanism of Blunt Ocular Trauma

Anterior segment

Posterior segment

Adnexa

Orbit

Location of Injury

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

Non invasive Out patient…

Ultrasonsogarphyin evaluation of a case with blunt trauma

*Difficult clinical examination.

* Uncooperative patient.

* To assess the extent of intraocular injuries.

Need for ultrasound

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.

Ultrasound biomicrscopy

UBM uses high frequency ultrasound (50-100MHZ) to produce images of the eye with high resolution (50 um) with reduced depth of penetration (5mm).

Structural abnormalities

Guide to treatment

Follow up after treatment

A new method for gonioscopy and

quantitative angle measurement

Orientations of the UBM probe

• Transverse sectionLateral extent

• Radial section

Examination Technique of UBM:

• Patient is lying down in supine position

• Monitor is at comfortable height

• Hand controller is in accessible position.

• Eye cup of suitable size separate the two lids, filled with saline solution.

Examples from our cases by

B-scan Ultrasound

Male patient of 45 years old was exposed to blunt trauma 2 years ago .. Clinical

examination show traumatic cataract

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

examination

A case with Vit. Hge that couldn't be detected clinically due to corneal oedema

A case with RD

Retinal break could be localized only by US

A case with PVD

Mobility of PVD is more than RD.

PVD becomes more prominent in higher gain settings

A case with retinal tear without detachment

A case with posterior lens dislocation

A case with PCIOL dislocation

A case with optic nerve avulsion

Retinal step sign from an edematous retina to bare sclera.

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

UBM examination showed subluxated lens with vitreous prolapsed in AC.

A case with iridodialysis

separation of the iris root from its attachment to the ciliary body

A cases with hyphema

A case with angle recession that couldn't be detected clinically

Tear in the ciliary body itself, between the circular and the longitudinal fibers

A case with cyclodialysis cleft

Separation of the ciliary body from the scleral spur resulting in cleft

A case with PCIOL dislocation