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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