0:00

We are continuing in the series of cases regarding trauma.

0:04

So this is the T of vitamin C and D, vascular, infectious,

0:08

traumatic, acquired, metabolic, idiopathic, neoplastic,

0:11

congenital and drugs. In this case,

0:14

as we scroll from top to bottom,

0:17

we note the difference in the shape of the vitreous.

0:22

So, as opposed to the previous case

0:24

where we were more concerned

0:25

about the anterior chamber and its depth,

0:28

in this situation, we are looking at the vitreous.

0:31

The vitreous, as you recall,

0:33

is that portion behind the lens of the

0:36

eye and as one can see in this case,

0:41

you have less depth in the vitreous on the

0:45

right side compared to the left side.

0:48

If one were to use the windowing function,

0:51

one might even be able to state that the density of the

0:56

vitreous is more dense than the vitreous on the left side,

1:01

and hence we have blood within the vitreous humor.

1:06

This does not mean that you should not continue

1:08

to look at the anterior chamber,

1:11

which again appears to be more dense than

1:14

the anterior chamber of the left eye.

1:17

So this patient has both an anterior hyphema,

1:21

that is blood in the anterior chamber, as well as rupture

1:25

of the globe of the vitreous posterior segment,

1:28

as well as blood within the vitreous humor.

1:31

And this can be viewed if one scrolls continuously.

1:37

And we note that the shape of the globe on the right side

1:44

the globe on the left side.

1:46

If we stop on this image,

1:48

we note low density within the anterior

1:54

chamber of the right globe.

1:58

When one has low density in the anterior

2:01

chamber or elsewhere around the globe,

2:04

one has to worry about the potential

2:07

for wood foreign bodies.

2:09

Now, wood can be more dense than CSF or soft tissue,

2:14

particularly if there is leaded wood,

2:18

versus less dense when we have soft wood,

2:21

like balsa wood, for example.

2:24

Foreign bodies associated with the globe is very important

2:29

to identify because it can be a source of infection.

2:33

And globe infection, endophthalmitis, has a natural course

2:39

which can lead to something called phthisis bulbi,

2:43

where the globe shrinks down and calcifies due

2:47

to the chronic infection. In this situation,

2:50

I would report on the anterior hyphema,

2:54

the globe rupture secondary to a foreign body,

2:59

which is likely to represent wood foreign body as opposed

3:04

to metallic foreign body because of the low density.

3:08

And I would include

3:10

the vitreous hemorrhage in this patient.