Ultrasound Case 009

Presentation

A 70 year old male who had been “legally blind” for several years presented after blunt ocular trauma. He had never had his eyes formally assessed. He said he had improved light perception post injury and could actually see moving shapes.


Describe and interpret these scans

IMAGE INTERPRETATION

Image: Ocular ultrasound:

The cornea, anterior chamber and iris appear normal. The lens contains a dense cataract and is dislocated from its usual position directly behind the centre of the pupil. Apart from the dislocated lens the posterior chamber is sonographically unremarkable.


CLINICAL CORRELATION

Dislocated lens with associated dense cataract.

Ocular ultrasound can be used to assess the entire eye. Here a very simple bedside scan reveals the cause of this patient’s improved light perception and acuity.

His previously light impervious lens has been displaced by trauma allowing passage of light directly to the retina. Without a lens, focus is not possible and acuity remains extremely poor.

The ocular trauma had fortuitously replicated one of the most ancient of surgical techniques known as “couching” where the opacified lens was deliberately pushed back into the vitreous to improve a patient’s acuity.


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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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