This document discusses blunt ocular trauma and summarizes a study examining 95 patients with blunt ocular trauma using B-scan ultrasound and ultrasound biomicroscopy (UBM). Key findings from the study include: 1) B-scan ultrasound and UBM detected structural changes like retinal tears and posterior capsule ruptures that were missed on clinical examination; 2) UBM provided high-resolution imaging of the anterior segment to diagnose injuries like iridodialysis and hyphema; 3) Ultrasonography is a useful non-invasive tool for evaluating and monitoring patients with blunt ocular trauma when clinical examination is limited.

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

5. 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 by
the orbital margin.

6. Pathophysiology of Blunt Ocular Trauma
 There are four main mechanisms:
1- Coup
2- Contrecoup
3- Equatorial expansion
4- Global repositioning

7. Location of Injury
 Anterior segment
 Posterior segment
 Adnexa
 Orbit

8. Anterior Segment
 Conjunctiva
 Cornea
 Iris & Ciliary body
 Lens & Zonules

9. Effects on the Cornea
Blood stained cornea
Corneal Abrasion
Corneal Edema

10. Effects on the Iris and Ciliary Body
Hyphema
Angle recession
Iridodialysis
Traumatic mydriasis
Cyclodialysis Cleft

11. Effects on the Lens and Zonules
• Traumatic cataract
• Vossius' Ring
• Lens Subluxation
• Lens Dislocation
• Anterior Capsule Rupture
• Posterior Capsule Rupture
• PCIOL Dislocation

12. Posterior Segment
 Vitreous
 Retina
 Choroid
 Optic nerve

13. Effects on the Vitreous
 Posterior vitreous detachment
• Vitreous hemorrhage

14. Effects on the Retina
 Rhegmatogenous retinal detachment
• Commotio retinae
• Retinal Hge
• Retinal Tear without detachment
• Retinal Dialysis

15. Effect on the Optic Nerve
 Optic nerve avulsion

16.  Ultrasound
 UBM

17. 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.

18. 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.

19. Orientations of the UBM probe
• Transverse section
Lateral extent
• Radial section

21. Patients and Methods
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,
US and UBM.
Exclusion criteria

22. 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.

23. 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 :

25. Age distribution of cases:

26. Type of traumatizing agents:

27. Visual Acuity among studied patients:

28. Findings by clinical examination:
Anterior Segment Posterior Segment

29. B-scan US findings:

30. UBM findings:

31. 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

32. Examples from our cases by
B-scan Ultrasound

33. 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

34. Vitreous Hemorrhage
Case II

35. Retinal Detachment
Case III

36. Posterior Vitreous Detachment
Case IV

37. Retinal tear without detachment
Case V

38. Lens Dislocation
Case VI

39. PCIOL Dislocation
Case VII

40. Examples from our cases by
UBM

41. 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.

42. Iridodialysis
Case II

43. Hyphema
Case III

44. Angle Recession
Case IV

45. Cyclodialysis Cleft
Case V

46. PCIOL Dislocation
Case VI

47. Conclusions

48.  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).

49.  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, iridociliary
unit and zonules.