|Year : 1984 | Volume
| Issue : 5 | Page : 285-288
Ultrasonography in perforating ocular injuries
HC Agarwal, NN Sood, Y Dayal
Dr. Rajendra Prasad Centre for Ophthalmic Sciences AIIMS, New Delhi, India
H C Agarwal
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi-110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agarwal H C, Sood N N, Dayal Y. Ultrasonography in perforating ocular injuries. Indian J Ophthalmol 1984;32:285-8
It is often difficult to assess the structural damage in perforating ocular injuries by direct ophthalmoscopic examination. The radiological examination, though necessary in every case, may not always be helpful. Some foreign bodies, like stone, wood and glass splinters can not be clearly seen in x-ray film. The purpose of this communication is to describe the role of "A Scan" and " B Scan" ultrasonography in perforating ocular injuries particularly with opaque media.
| Materials and methods|| |
Ultrasonography both A and B scan were carried out in 173 eyes of 173 patients of perforating ocular injury, using ophthalmoscan model 200, by immersion technique. All cases had a detailed clinical examination. A radiological examination. was performed to detect and localise the intraocular foreign body before performing ultrasonography. The patient was explained the procedure. He was requested to lie on the examination table. A quickfix solution was applied in a circle around the eye. The lids were separated with an eye speculum. A plastic steri-drape was affixed. The eye was enaesthetised with 4% xylocaine drops. About 500 ml sterile normal saline was poured slowly down the edge of the drape as stand off. The transducer assembly was slowly lowered until the face of the transducer was in contact with water.
The scanning was started with l0MHz transducer with sensitivity setting at optimum. A continuous sector scanning was performed at 2 mm in vertical and horizontal meridia. When the lesion was identified the gain was increased to the maximum to demonstrate low amplitude changes such as vitreous haemorrhage more easily. The gain was then reduced to minimum to delineate the high amplitude abnormalities such as retinal detachment or intraocular foreign body.
The detected abnormality on A and B Scan were studied and photographs were taken using 400 ASA, 35 mm film loaded in a camera with close up.
| Observations|| |
The various types of lesions seen in 173 eyes are described in [Table - 1]. In most of the eyes more than one pathology was seen.
In 44 cases of recent injuries with light vitreous haemorrhage a chain of low to medium amplitude spike with 10-60% reflectivity was seen along the base line of ultrasonogram. There was always presence of after movement. The location of haemorrhage was better appreciated on B Scan [Figure - 1].
In 22 cases of old perforating injury the presence of high amplitude spikes with 60-100 reflectivity with dB more than 18 and associated slight to moderate after movement suggested the presence of organised vitreous haemorrhage with membrane formation [Figure - 2].
Intraocular foreign body
On A scan the foreign body characteris" tically produced high amplitude spike exceeding that of sclera. Forty seven were located in the vitreous, three in the coats of the eye ball and two in the lens. The size of the foreign body was more than 2 mm in all cases [Figure - 3][Figure - 4][Figure - 5].
On A scan ultrasonography total retinal detachment was found in 10 cases and involvement of one to three quadrants in 15 cases. On A scan with sound beam at tissue sensitivity and perpendicular to the retinal surface retinal detachment was characterised by a single high amplitude spike with 100 percent reflectivity.
On serial horizontal and vertical plane B scan ultra sonography, the site, shape extension as well as maximum height could be delineated. The totally detached retina appeared as convex bullae extending into vitreous being attached at the nasal and temporal ora serrata and at the optic disc. The absence of any ultrasonic signal between the retinal spike and the scleral spike suggested serous detachment. On quantitative echography a value of 15 dB or less supported the diagnosis. Moreover, during kinetic echography detached retina produced after movements of their echospikes. In cases of long standing retinal detachment the retina appeared as funnel shaped. Presence of cystic changes was also seen in cases of old perforating injury with total retinal detachment.
| Discussion|| |
In cases of perforating ocular injuries presence of opaque media such as corneal opacification, cataractous lens or vitreous opacity does not permit ophthalmoscopic visualization of fundus. In these cases a structural change as well as associated intraocular foreign bodies can be studied by echographic examination of the injured eye.
The vitreous haemorrhage as regards its location, extent and response to treatment can be judged by repeat echography during follow up. Vitreous haemorrhage organisation into a fibrous membrane may lead to retinal detachment. Such changes can be demonstrated by A and B scan ultrasonography.
Echographic detection and localization of intraocular foreign body can be simplified by prior radiological assessment if the foreign body is radio-opaque. In two cases the metalic foreign body located in the lens did not show up on x-ray examination. But the clinical suspicion was confirmed on A and B scan ultrasonography. If the foreign body is radioluscent it can be easily detected by echography if the size is above 0.2 mm.
Ultrasonography in perforating ocular injuries is further helpful in determination of site and extent of intraocular pathology. This information is extremely helpful in planning microsurgical management of such eyes. Presence of multiple traction bands in the vitreous, retinal detachment with cystic degeneration and periretinal membrane formation are relatively bad prognostic signs.
| Summary|| |
Ultrasonic evaluation in 173 cases of perforating ocular injury revealed presence of retinal detachment in 25 eyes, vitreous haemorrhage in 44 eyes, vitreous haemorrhage without or with organisation in 66 eyes. Associated intraocular foreign body was found in 52 eyes. In two cases the iron foreign body located in the lens could not be revealed by x-ray examination. In three cases the iron foreign body was present in the coats of the eye ball and in 52 cases in the vitreous.
| References|| |
Bruckner H.L., 1971. Ann. Ophthalmol, 3: 1014
Buschman W. and Hauff D., 1967. Ann. Ophthalmol, 63: 926
Coleman DJ., Jack R.L. and Franrigen LA, 1973. Amer. J. Ophthalmol, 75: 279
Oksala A and Lehtinen A, 1959. Brit J.Ophthalmol, 43: 744
Sanna G. and Quilici G., 1963. Ann. Ophthalmol, 89:877
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9]
[Table - 1]