by Mohamed Ahmed ELShafie

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

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

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.

27. Age distribution of cases:

28. Type of traumatizing agents:

29. Visual Acuity among studied patients:

31. Anterior segment findings
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%

32. Posterior segment findings
0%
5%
10%
15%
20%

33. B-scan Ultrasound results

34. UBM results

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

52. Conclusions

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.