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Certain types of trauma can cause significant enough periorbital edema that it can be challenging to retract the eyelids of patients. It is important to assess extraocular eye movements to detect muscular entrapment or cranial nerve defects.
Retrobulbar hemorrhage is a rare finding that occurs when blood accumulates in the retrobulbar space, often from orbital trauma or postoperative complications from eye surgery.
This condition is an ocular emergency as the quick elevation of retro-orbital pressure can cause reduced circulation, ischemia, and finally necrosis of the optic nerve with irreversible blindness.
Patients often present with sudden-onset pain, proptosis, conjunctival edema, or limited extra-ocular movements.
On ocular ultrasound, you may see a “Guitar Pick Sign” where the increased pressure from the retrobulbar hematoma distorts the spherical globe into a conical shape.
Lens dislocation typically occurs after blunt or penetrating trauma and can be partial (subluxation) or complete lens dislocations.
These patients often present with a change in vision (blurring, double vision, seeing the edge of the lens) and normal pupillary response.
On ocular ultrasound, you will see the lens as a bi-convex structure with hyperechoic borders floating posteriorly in the vitreous body.
Globe rupture occurs when a blunt or penetrating trauma disrupts the integrity of the outer membranes of the eye. Traumatic globe rupture is a major ophthalmologic emergency and must be referred to ophthalmology immediately.
These patients present with painful vision loss and extrusion of vitreous fluid.
(Note: Some may say globe rupture is a relative contraindication to ocular ultrasound. Use extreme care and copious amounts of gel if you are attempting ultrasound on a patient with suspected globe rupture. Any additional pressure on the eye from the transducer can worsen extrusion of the vitreous humor.)
On ocular ultrasound, you may find buckling of the sclera, asymmetric loss of the normal spherical shape of the globe, decreased size of globe, flattening or compression of the anterior chamber, or often have vitreous hemorrhage.
Foreign bodies can enter the eye and lead to globe rupture, infection, retinal toxicity, and vision loss if not removed.
These patients often present with a painful foreign body sensation in the eye, decreased vision, redness, tearing, flashes, or floaters.
On ocular ultrasound, you can find a bright, hyperechoic object with an associated reverberation artifact (if object is metallic).
Traumatic Retinal Detachments will have similar ocular ultrasound findings to atraumatic retinal detachments as described above.
