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: 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.
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.