A. Globe rupture
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Do NOT perform ultrasound if known globe rupture
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Presentation:
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Painful vision loss after high impact blunt or penetrating trauma
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Can visualize distortion of pupil, extrusion of vitreous fluid and prolapse of internal structures on physical exam
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Findings:
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Decrease in size of the globe
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Anterior chamber collapse
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Vitreous hemorrhage (see below)
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Disruption of normal globe architecture
Globe Rupture – Source: Dr Craig Hacking, https://radiopaedia.org/From the case https://radiopaedia.org/cases/35142
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Retrobulbar Hematoma
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Presentation:
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Proptosis
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Elevated intraocular pressure (>40 mmHg)
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Decreased visual acuity after trauma
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Findings:
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Hypoechoic fluid collection posterior to the globe
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Note: This is an ocular emergency and can lead to permanent vision loss if not decompressed rapidly
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In cadaver lab study: Sensitivity 85%, Specificity 89%, PPV 66%, NPV 95.9% for EM residents. EM US fellowship trained attendings had a sensitivity of 100% (Gibbons 2018)
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Foreign Body
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Presentation:
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Secondary to eye trauma, notably projectile penetrating trauma
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Can present with or without pain and vision loss
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May be asymptomatic
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Note: Even asymptomatic foreign bodies can progress to permanent vision loss so all patients should be carefully evaluated
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Findings:
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Hyperechoic object, possibly producing shadow or comet tail artifact
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Can also see “twinkle” artifact when color doppler is applied
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In porcine model with metallic foreign bodies: Sensitivity 88%, Specificity 96%, PPV 96%, NPV 85% (Shiver 2005, PMID: 16179616)
Foreign Body – Source: Dr Maulik S Patel, https://radiopaedia.org/From the case https://radiopaedia.org/cases/21698
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Lens Detachment
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Presentation: May present as decreased vision with a normal pupillary response and without signs of open globe injury
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Note: Usually due to trauma. Occurrences in children or secondary to minor trauma should prompt investigation for an underlying genetic cause
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Findings: Posteriorly-displaced lens
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Sensitivity 84.6%, Specificity 98.3%, Positive Likelihood Ratio 49.5, Negative Likelihood Ratio 0.15 (Haghighi 2014, PMID: 26495362)
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