Us and UBM examination

ultrasound and ultrasound biomicroscopy examination

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

14. *Difficult clinical examination. * Uncooperative patient. * To assess the extent of intraocular injuries. Need for ultrasound

15. 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.

16. 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).

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

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

19. 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.

20. Examples from our cases by B-scan Ultrasound

21. 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

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

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

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

25. A case with retinal tear without detachment

26. A case with posterior lens dislocation

27. A case with PCIOL dislocation

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

29. Examples from our cases by UBM

30. 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.

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

32. A cases with hyphema

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

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

35. A case with PCIOL dislocation

36. Thank You