ultrasonic evaluation of eyes with blunt trauma
TRANSCRIPT
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Supervisors
Professor Doctor
Eman Mohamed El-HefnyProfessor of ophthalmology
Doctor
Maha Mohamed Othman Assistant Professor of ophthalmology
Doctor
Hossam Abo El-KhierLecturer of ophthalmology
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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
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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.
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Pathophysiology of Blunt Ocular Trauma
There are four main mechanisms:
1- Coup
2- Contrecoup
3- Equatorial expansion
4- Global repositioning
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Location of Injury Anterior segment
Posterior segment
Adnexa
Orbit
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Anterior Segment
Conjunctiva
Cornea
Iris & Ciliary body
Lens & Zonules
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Effects on the Cornea
Blood stained cornea
Corneal Abrasion
Corneal Edema
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Effects on the Iris and Ciliary Body
HyphemaAngle recessionIridodialysis
Traumatic mydriasis
Cyclodialysis Cleft
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Effects on the Lens and Zonules
• Traumatic cataract
• Vossius' Ring
• Lens Subluxation
• Lens Dislocation
• Anterior Capsule Rupture
• Posterior Capsule Rupture
• PCIOL Dislocation
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Posterior Segment
Vitreous
Retina
Choroid
Optic nerve
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Effects on the Vitreous
Posterior vitreous detachment
• Vitreous hemorrhage
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Effects on the Retina
Rhegmatogenous retinal detachment
• Commotio retinae
• Retinal Hge
• Retinal Tear without detachment
• Retinal Dialysis
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Effect on the Optic Nerve
Optic nerve avulsion
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Ultrasound
UBM
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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.
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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.
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Orientations of the UBM probe
• Transverse sectionLateral extent
• Radial section
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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
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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.
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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 :
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Age distribution of cases:
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Type of traumatizing agents:
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Visual Acuity among studied patients:
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Findings by clinical examination:
Anterior Segment Posterior Segment
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B-scan US findings:
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UBM findings:
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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
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Examples from our cases by
B-scan Ultrasound
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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
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Vitreous Hemorrhage
Case II
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Retinal Detachment
Case III
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Posterior Vitreous Detachment Case IV
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Retinal tear without detachment
Case V
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Lens Dislocation
Case VI
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PCIOL Dislocation
Case VII
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Examples from our cases by
UBM
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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.
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Iridodialysis
Case II
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Hyphema
Case III
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Angle Recession
Case IV
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Cyclodialysis Cleft Case V
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PCIOL DislocationCase VI
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Conclusions
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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).
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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.
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