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Supervisors
Professor Doctor
Eman Mohamed El-Hefny
Professor of ophthalmology
Doctor
Maha Mohamed Othman
Assistant Professor of ophthalmology
Doctor
Hossam Abo El-Khier
Lecturer of ophthalmology
Discussion committee
Professor Doctor
Ahmed Mostafa Ismail
Professor of Ophthalmology
Mansoura University
Professor Doctor
Eman Mohamed El-Hefny
Professor of ophthalmology
Professor Doctor
Mohamed Alsbaey Shahin
Professor of Ophthalmology
Suez Canal University
By/Mohamed Ahmed El –Shafie
Resident in ophthalmology department Mansoura
University
Thesis
Submitted for partial fulfillment of the Ms in Ophthalmology
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, the
eye itself may take most of the
impact.
 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
Hyphema
Angle recession
Iridodialysis
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…
Ultrasonsogarphy
in evaluation of a case with blunt trauma
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).
Orientations of the UBM probe
• Transverse section
Lateral extent
• Radial section
This 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.
Exclusion criteriaInclusion criteria
Patients presented with closed globe injuries
For all patients, the following were 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:
Using HUMPHRY A/B scan system Model 835.
4) UBM:
Using HUMPHRY Model 840.
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.
Age distribution of cases:
Type of traumatizing agents:
Visual Acuity among studied patients:
Anterior segment findings
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
Posterior segment findings
0%
5%
10%
15%
20%
B-scan Ultrasound results
UBM results
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 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
Conclusions
 Ultrasonography is considered as a mandatory tool in
evaluation of patients 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 is a useful tool in detection of ocular pathology
after trauma especially in detection of cyclodialysis and
angle recession.
Ultrasonic evaluation of eyes with blunt trauma

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Ultrasonic evaluation of eyes with blunt trauma

  • 1.
  • 2. Supervisors Professor Doctor Eman Mohamed El-Hefny Professor of ophthalmology Doctor Maha Mohamed Othman Assistant Professor of ophthalmology Doctor Hossam Abo El-Khier Lecturer of ophthalmology
  • 3. Discussion committee Professor Doctor Ahmed Mostafa Ismail Professor of Ophthalmology Mansoura University Professor Doctor Eman Mohamed El-Hefny Professor of ophthalmology Professor Doctor Mohamed Alsbaey Shahin Professor of Ophthalmology Suez Canal University
  • 4. By/Mohamed Ahmed El –Shafie Resident in ophthalmology department Mansoura University Thesis Submitted for partial fulfillment of the Ms in Ophthalmology
  • 5.
  • 6. 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, the eye itself may take most of the impact.
  • 7.  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
  • 8.  Anterior segment  Posterior segment  Adnexa  Orbit Location of Injury
  • 9. Anterior Segment  Conjunctiva  Cornea  Iris & Ciliary body  Lens & Zonules
  • 10. Effects on the Cornea Blood stained cornea Corneal Abrasion Corneal Edema
  • 11. Effects on the Iris and Ciliary Body Hyphema Angle recession Iridodialysis Traumatic mydriasis Cyclodialysis Cleft
  • 12. Effects on the Lens and Zonules • Traumatic cataract • Vossius' Ring • Lens Subluxation • Lens Dislocation • Anterior Capsule Rupture • Posterior Capsule Rupture • PCIOL Dislocation
  • 13. Posterior Segment  Vitreous  Retina  Choroid  Optic nerve
  • 14. Effects on the Vitreous  Posterior vitreous detachment • Vitreous hemorrhage
  • 15. Effects on the Retina  Rhegmatogenous retinal detachment • Commotio retinae • Retinal Hge • Retinal Tear without detachment • Retinal Dialysis
  • 16. Effect on the Optic Nerve  Optic nerve avulsion
  • 17.  Non invasive  Out patient… Ultrasonsogarphy in evaluation of a case with blunt trauma
  • 18. 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.
  • 19. 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).
  • 20. Orientations of the UBM probe • Transverse section Lateral extent • Radial section
  • 21.
  • 22. This 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. Exclusion criteriaInclusion criteria Patients presented with closed globe injuries
  • 23. For all patients, the following were 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.
  • 24. 3) B-scan Ultrasonography: Using HUMPHRY A/B scan system Model 835. 4) UBM: Using HUMPHRY Model 840.
  • 25. 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.
  • 26.
  • 29. Visual Acuity among studied patients:
  • 30.
  • 35. 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.
  • 36. Examples from our cases by B-scan Ultrasound
  • 37. 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
  • 38. A case with Vit. Hge that couldn't be detected clinically due to corneal oedema
  • 39. A case with RD Retinal break could be localized only by US
  • 40. A case with PVD Mobility of PVD is more than RD. PVD becomes more prominent in higher gain settings
  • 41. A case with retinal tear without detachment
  • 42. A case with posterior lens dislocation
  • 43. A case with PCIOL dislocation
  • 44. A case with optic nerve avulsion Retinal step sign from an edematous retina to bare sclera.
  • 45. Examples from our cases by UBM
  • 46. 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.
  • 47. A case with iridodialysis separation of the iris root from its attachment to the ciliary body
  • 48. A cases with hyphema
  • 49. A case with angle recession that couldn't be detected clinically Tear in the ciliary body itself, between the circular and the longitudinal fibers
  • 50. A case with cyclodialysis cleft Separation of the ciliary body from the scleral spur resulting in cleft
  • 51. A case with PCIOL dislocation
  • 53.  Ultrasonography is considered as a mandatory tool in evaluation of patients 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).
  • 54.  High frequency ultrasound (Ultrasound Biomicroscopy) can provide a high resolution of the anterior segment of the eye (4mm x 4 mm).  UBM is a useful tool in detection of ocular pathology after trauma especially in detection of cyclodialysis and angle recession.

Editor's Notes

  1. I can apply the probe in different techniques:in transverse I apply brope tangential to limbus..in long probe is perpendicular to limbus,mark to ward limbus…in axial brope through cornea
  2. The probe was placed over the limbus in radial fashion
  3. with anesthetic drops. The...
  4. Most of the patients were in the age group of 10-20 years
  5. Fresh hemorrhage dots or lines Old hemorrhage dots gets brighter
  6. bright continuous, folded mem. Of high spike with insertion into the disc and ora serrata.
  7. Mobility of PVD is more than RD. PVD becomes more prominent in higher gain settings
  8. Adherence of posterior hyaloid to peripheral retinal tear
  9. Retinal step sign from an edematous retina to bare sclera. Vitreous hemorrhage
  10. separation of the iris root from its attachment to the ciliary body
  11. tear is in the ciliary body itself, between the circular and the longitudinal fibers