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

1. UBM and US of Eye
Mohamed ELShafie
Assistant lecturer of ophthalmology
Kafr ELShiekh university

2. 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.

3.  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

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

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

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

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

8. Effects on the Lens 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 the Vitreous
 Posterior vitreous detachment
• Vitreous hemorrhage

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

12. Effect on the Optic 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 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. 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).

19.  Structural abnormalities
Guide to treatment
Follow up after treatment
A new method for gonioscopy and
quantitative angle measurement

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

21. 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.

23. Examples from our cases by
B-scan Ultrasound

24. 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

25. A case with Vit. Hge that couldn't be detected
clinically due to corneal oedema

26. A case with RD
Retinal break could be localized only by US

27. A case with PVD
Mobility of PVD is more than RD.
PVD becomes more prominent in higher gain settings

28. A case with retinal tear without
detachment

29. A case with posterior lens dislocation

30. A case with PCIOL dislocation

31. A case with optic nerve avulsion
Retinal step sign from an edematous retina to bare sclera.

32. Examples from our cases by
UBM

33. 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.

34. A case with iridodialysis
separation of the iris root from its attachment to the ciliary body

35. A cases with hyphema

36. A case with angle recession that couldn't
be detected clinically
Tear in the ciliary body itself, between the circular and the longitudinal fibers

37. A case with cyclodialysis cleft
Separation of the ciliary body from the scleral spur resulting in cleft

38. A case with PCIOL dislocation