Interactive Transcript
0:01
When we think about ocular injury,
0:03
we have to know a little bit about the anatomy of the globe.
0:07
So, ocular injury, we're referring to the globe. And we like
0:11
to think of the globe in terms of these various segments of the globe.
0:15
We talked initially about the anterior
0:17
segment, which includes the anterior, the anterior chamber,
0:20
the lens and the uveal body.
0:22
And we'll talk a little bit about
0:23
the anatomy of the uveal body.
0:25
Then we have the posterior chamber.
0:26
Suffice it to say that this is such a small area of the globe that we actually
0:31
don't see very much trauma to the posterior chamber.
0:35
The large area behind the lens is actually the vitreous.
0:38
And within the vitreous, we also look at the vitreous membranes
0:42
of which the chloroid and the retina are most important.
0:45
The sclera is the ocular membrane that is on the outermost portion of the globe.
0:51
So here is a diagram of a globe, and I will
0:56
point out what we talked about initially, which is the surface of the globe,
1:02
in front of the lens, is the cornea. You see labeled here.
1:06
You see that there is an anterior chamber,
1:11
which is labeled here. Anterior chamber just behind the cornea
1:16
and in front of the lens.
1:18
The posterior chamber, which, as I said, is a very small area that we really are
1:23
unable to discern pathology in, is labeled here.
1:28
It's behind the anterior chamber, obviously, and in front of the vitreous,
1:32
and it is in close approximation to the lens.
1:36
I talked about the uveal tract, and the uveal tract includes the ciliary
1:42
body with the ciliary muscle, as well as portions of the choroid.
1:47
The choroid, as you can see here, is labeled in red.
1:51
And it goes all the way up to communicate
1:55
with that ciliary apparatus at the uveal tract.
2:00
So if we follow the choroid all the way
2:03
back, we can see it goes all the way back to the insertion site of the optic nerve.
2:09
Let's look at the membrane that is
2:11
superficial to the choroid, that is the retina.
2:14
So the retina is seen as this yellowish material, which stops at this juncture.
2:22
When we look at it on the axial scan, it's usually at 10 o'clock and 2 o'clock.
2:26
This will be 2 o'clock, this would be 10 o'clock.
2:28
And the area where it stops is known as the ora serrata.
2:33
So the retina does not go up as far as
2:36
the uveal tract, the ciliary apparatus, whereas the choroid does.
2:42
And that's going to be helpful to us
2:44
in separating choroidal detachments from retinal detachments.
2:48
And then finally, we have the outermost
2:51
covering of the globe, and that is the sclera.
2:55
And we could sort of follow that all
2:57
the way up until it communicates with the cornea.
3:00
And again, here is the sclera over here.
3:03
And we saw a little area of scleral injury on the first case that was shown.
3:09
So here is the junction of the optic nerve
3:12
with the posterior aspect of the globe and the communication with the retina.
3:16
And this area here is usually referred to as the papilla.
3:20
And we have this little hyaloid canal, which is obliterated with maturation.
3:25
So looking at this diagrammatically. Again, we see the choroid as it continues
3:31
into the ciliary body, and the retina, which stops beforehand.
3:38
And I mentioned the uveal track
3:40
which consists of the iris, which is the colored portion
3:43
of the eyeball, the ciliary body and the choroid.
3:48
This is another example of ocular injury.
3:51
And once again on the right side this time, which might imply a left handed
3:56
person who is hitting the person in the eye with the fist.
3:59
Here we see the soft tissues lying superficially.
4:02
We see the outline of the sclera leading to the cornea.
4:06
We see that the anterior chamber on the affected eye is of higher density
4:12
than the anterior chamber on the unaffected eye.
4:15
We see that the depth of the anterior chamber on the left side is greater than
4:20
the depth of the anterior chamber on the right side.
4:24
So there is indeed anterior chamber globe rupture.
4:27
And then we see this unusual appearance.
4:30
It's almost a right angle here to the lens, which has also been traumatized.
4:34
The lens is less dense than the lens on the left side.
4:38
Again, a traumatic cataract with lens
4:42
rupture, anterior chamber hyphema, anterior chamber rupture.
4:47
And the vitreous looks just fine.
4:50
So when we think about the location
4:53
of blood, blood in the anterior chamber, you'll hear this quite frequently
4:57
from the ophthalmologist, is called anterior hyphema.
5:00
It'll be labeled on the ophthalmology note as A.H.
5:04
Posterior chamber blood is not in the vitreous, it's in the posterior chamber.
5:08
Let's go back to this. Here's this little area known as the posterior chamber.
5:12
We usually don't discern blood
5:14
in that location, but they may refer to a posterior hyphema.
5:18
Hemorrhage in the vitreous is called vitreous hemorrhage, obviously,
5:22
and that's in the big part of the globe behind the lens.
5:25
And then we can talk about the various types of detachments of the membranes.
5:29
And the two most common are coroidal detachment and retinal detachment.
© 2024 Medality. All Rights Reserved.