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Us and UBM examination
This document discusses the pathophysiology and evaluation of blunt ocular trauma using ultrasound techniques. It begins by explaining the different mechanisms of blunt trauma impact depending on the size of the object hitting the eye. It then outlines the different locations within the eye that can be injured, including the anterior segment, posterior segment, adnexa, and orbit. The document proceeds to describe specific injuries that can occur to structures like the cornea, iris, lens, vitreous, retina, and optic nerve. It emphasizes the importance of ultrasound, particularly ultrasonography and ultrasound biomicroscopy, in evaluating intraocular injuries and structural abnormalities in cases of blunt trauma where clinical examination is difficult or limited. Finally, it provides examples of ultrasound findings from
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Us and UBM examination
- 1. UBM and USof Eye Mohamed ELShafie Assistant lecturer of ophthalmology Kafr ELShiekh university
- 2. Pathophysiology of BluntOcular 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.
- 3. There arefour 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
- 4. Anterior segment Posterior segment Adnexa Orbit Location of Injury
- 5. Anterior Segment Conjunctiva Cornea Iris & Ciliary body Lens & Zonules
- 6. Effects on theCornea Blood stained cornea Corneal Abrasion Corneal Edema
- 7. Effects on theIris and Ciliary Body Hyphema Angle recession Iridodialysis Traumatic mydriasis Cyclodialysis Cleft
- 8. Effects on theLens and Zonules • Traumatic cataract • Vossius' Ring • Lens Subluxation • Lens Dislocation • Anterior Capsule Rupture • Posterior Capsule Rupture • PCIOL Dislocation
- 9. Posterior Segment Vitreous Retina Choroid Optic nerve
- 10. Effects on theVitreous Posterior vitreous detachment • Vitreous hemorrhage
- 11. Effects on theRetina Rhegmatogenous retinal detachment • Commotio retinae • Retinal Hge • Retinal Tear without detachment • Retinal Dialysis
- 12. Effect on theOptic Nerve Optic nerve avulsion
- 13. Non invasive Out patient… Ultrasonsogarphy in evaluation of a case with blunt trauma
- 15. *Difficult clinical examination. *Uncooperative patient. * To assess the extent of intraocular injuries. Need for ultrasound
- 16. Orientations of theB-scan Probe • Axial: Lesion in relation to lens &optic nerve . •Transverse: Lateral extent, 6 clock hours . •Longitudinal: AP extent,1 clock hour.
- 18. Ultrasound biomicrscopy UBM useshigh frequency ultrasound (50-100MHZ) to produce images of the eye with high resolution (50 um) with reduced depth of penetration (5mm).
- 19. Structural abnormalities Guideto treatment Follow up after treatment A new method for gonioscopy and quantitative angle measurement
- 20. Orientations of theUBM probe • Transverse section Lateral extent • Radial section
- 21. Examination Technique ofUBM: • 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.
- 23. Examples from ourcases by B-scan Ultrasound
- 24. Male patient of45 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
- 25. A case withVit. Hge that couldn't be detected clinically due to corneal oedema
- 26. A case withRD Retinal break could be localized only by US
- 27. A case withPVD Mobility of PVD is more than RD. PVD becomes more prominent in higher gain settings
- 28. A case withretinal tear without detachment
- 29. A case withposterior lens dislocation
- 30. A case withPCIOL dislocation
- 31. A case withoptic nerve avulsion Retinal step sign from an edematous retina to bare sclera.
- 32. Examples from ourcases by UBM
- 33. 25 years oldman 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.
- 34. A case withiridodialysis separation of the iris root from its attachment to the ciliary body
- 35. A cases withhyphema
- 36. A case withangle recession that couldn't be detected clinically Tear in the ciliary body itself, between the circular and the longitudinal fibers
- 37. A case withcyclodialysis cleft Separation of the ciliary body from the scleral spur resulting in cleft
- 38. A case withPCIOL dislocation
Editor's Notes
- #17 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
- #21 The probe was placed over the limbus in radial fashion
- #22 with anesthetic drops. The...
- #26 Fresh hemorrhage dots or lines Old hemorrhage dots gets brighter
- #27 bright continuous, folded mem. Of high spike with insertion into the disc and ora serrata.
- #28 Mobility of PVD is more than RD. PVD becomes more prominent in higher gain settings
- #29 Adherence of posterior hyaloid to peripheral retinal tear
- #32 Retinal step sign from an edematous retina to bare sclera. Vitreous hemorrhage
- #35 separation of the iris root from its attachment to the ciliary body
- #37 tear is in the ciliary body itself, between the circular and the longitudinal fibers