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This first case is a case of a child who is punched

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in the right eye. For evaluation of orbital trauma,

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it's good to start initially with the thick slice images

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and then work to the thinner slices

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images to get better resolution.

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These are the 3 mm slice images through the

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orbits that I am scrolling through in the axial plane.

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In this case,

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what strikes me almost immediately is the difference in

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the density between the left lens and the right lens.

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The left lens,

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as seen on this image,

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has higher density than the right lens.

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Not only is the lens less dense on the right side,

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but it has a somewhat amorphous appearance to it

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as opposed to the more normal appearance of the left lens.

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My eyes are then drawn anteriorly in front

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of the lens to the anterior chamber.

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The anterior chamber on the right side is also more

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dense than the anterior chamber on the left side,

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which has the same density as the vitreous.

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I also note that the depth of the anterior chamber is more

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shallow on the right side compared with the left side.

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Let's scroll through the images and make sure that

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this is consistent on additional slices.

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Once again,

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one can see on the right side that the anterior chamber in

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front of the lens is more dense and more shallow in

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an AP dimension than the left anterior chamber.

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The discussion of this case would revolve around these

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findings as well as the findings revolving around the lens.

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Blood in the anterior chamber

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is called anterior hyphema.

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This accounts for the higher density in the right anterior

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chamber compared to the left anterior chamber.

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Decrease in the

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dimension of the anterior chamber suggests that

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the globe has been ruptured.

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Most times, when we think about globe rupture,

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we're looking at the vitreous, and that looks flat

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or not as large as the contralateral side.

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However,

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more common than vitreous chamber rupture

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is anterior chamber rupture,

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demonstrated by the decrease in the anterior to

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posterior dimension of the anterior chamber.

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What do we say about the lens?

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A traumatic cataract

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is one in which the lens is less dense because

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of edema than the normal lens.

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This is to be distinguished from a senescent or senile

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cataract of older age,

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where the lens becomes desiccated

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and becomes more dense.

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This lens also is not in the appropriate

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location centered in the globe.

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My impression of this case would be globe rupture of the

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anterior chamber with anterior hyphema associated with

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a traumatic cataract which is dislocated laterally.