0:00

This is another case in the series of trauma examples to

0:05

the globe, ocular trauma.

0:07

In this case, not so subtly

0:10

one sees that the density of the right globe is much

0:14

more dense than the density of the left globe,

0:17

including both the anterior chamber,

0:19

as well as the vitreous.

0:23

The anterior chamber is well seen on the left side,

0:27

in part because the patient has a lens

0:30

implant for cataract surgery,

0:32

and the vitreous of the left side is also well visualized.

0:37

However, that distinction between anterior chamber

0:40

and the vitreous is not identified on

0:43

the right side because of the hemorrhage

0:46

that is in both chambers. And in this case, the patient who

0:50

had a lens implant is no longer able to be identified.

0:54

At the inferior aspect of this globe,

0:58

one sees an outpouching.

1:00

This is actual portions of the vitreous which is

1:04

perforating out through the ruptured globe.

1:07

When one has an opening in the globe and it is ruptured in

1:13

this fashion is very dangerous from the standpoint of

1:17

contracting an infection leading to endophthalmitis.

1:21

In this situation,

1:23

the ophthalmologist was not able to evaluate the globe,

1:28

in part because the hemorrhage in the anterior chamber

1:32

precluded visualization beyond the

1:35

lens implant into the vitreous.

1:38

So while the ophthalmologist identified that

1:40

the patient had an anterior hyphema,

1:42

he could not see past the hemorrhage

1:47

to identify pathology in the posterior segment

1:50

and the vitreous humor.

1:53

This is an important distinction because

1:56

since this patient has an open globe,

1:59

the ophthalmologist cannot employ ultrasound

2:02

to evaluate this patient.

2:04

Ultrasound, when the patient has an opening

2:06

in the globe, is contraindicated because

2:09

of that risk of infection, and therefore,

2:12

the ophthalmologist is blind to what is

2:15

happening posterior to the anterior segment.

2:18

For this,

2:19

the ophthalmologist requires the radiologist's

2:22

interpretation of the CT scan of the orbits,

2:25

in this case, demonstrating the rupture of the

2:28

lens implant, as well as vitreous hemorrhage.