ubm of blunt trauma in pediatric population

UBM of Blunt Traumain Pediatric Population

Mohamed ELShafie Assistant lecturer of ophthalmology

Kafr ELShiekh university

We always get trauma in our hospitals most of these injuries are 2ry to blunt object

Pathophysiology of Blunt Ocular Trauma

If a large object hits the eye, most of the impact is usually taken by the orbital margin.

• There are four main mechanisms:1- Coup (injury at the same point)2- Contrecoup (injury at the opposite point)3- Equatorial expansion4- Global repositioning

Mechanism of Blunt Ocular Trauma

Effects on the Cornea

Blood stained cornea

Corneal Abrasion

Corneal Edema

Effects on the Iris and Ciliary BodyHyphemaAngle recessionIridodialysisTraumatic mydriasisCyclodialysis Cleft

Effects on the Lens and Zonules• Traumatic cataract• Lens Subluxation• Anterior Capsule Rupture• Posterior Capsule Rupture

A meticulous evaluation& appropriate treatment of the traumatized eye are crucial in preventing visual impairment.

However, evaluation of anterior segment by clinical examination alone is limited by trauma related media opacities.

Ultrasound Biomicroscopy

High frequency ultrasound (50-100MHZ)

Images with high resolution (50 um)

Depth of penetration (5mm)

Can image through opaque cornea

Coupling media: Fluid

Patient position: Supine

Skilled examiner

Time consuming

Study included 95 eyes of 95 patients representing with blunt

ocular trauma attending the outpatient clinics of Mansoura

ophthalmic center during the period from October 2013 to

October 2014.

Comparison between clinical and UBM findings:

UBM detect structural changes which may be missed or can’t be detected by clinical examination especially with opaque media.

FindingClinical evaluation

UBM

evaluation P value

No % No %

Iridodialysis 20 21.1% 25 26.3% 0.394

Hyphema 43 45.3% 45 47.4% 0.771

Angle recession 1 1.1% 7 7.4% 0.030*

Cyclodialysis 2 2.1% 4 4.2% 0.407

Lens subluxation 7 7.4% 12 12.6% 0.227

17 years old patient 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.

A case with angle recession that couldn't be detected clinically

Tear in the ciliary body itself, between the circular and the longitudinal fibers

 A 6-year-old child with traumatic cataract. UBM evaluation was useful in detecting zonular

dialysis before surgery.

Separation of the ciliary body from the scleral spur resulting in cleft

 A 14 year-old patient exposed in her right eye to a rocket firework followed by hypotony.Cyclodialysis was obvious by UBM

• Never take blunt trauma to eye lightly.

• In the setting of ocular trauma, you must first “take a step back” and examine the eye in detail.

• UBM is a useful tool in detection of ocular pathology after trauma especially in detection of cyclodialysis and angle recession.

Take Home Message

Thank You