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Diagnose on Sight: Traumatic Vision Loss

2016-12-22T18:44:45+00:00

lens dislocationCase: A 60 year old male presents after being hit by an automobile while riding his bicycle. He has significant blunt head trauma. His left eye is pictured here. What is the diagnosis?

 

Poll Results

Answer

Lens dislocation

Explanation

Crystalline lens dislocation, also referred to as ectopia lentis, most commonly occurs secondary to ocular trauma. Disruption of the zonular fibers which hold the lens in place allow the migration of the lens. If the lens completely dislocates it can be found in the anterior chamber, free-floating in the vitreous, or over the retina.1

Patients may complain of:

  • Pain
  • Diplopia
  • Photosensitivity
  • Blurry vision
  • Partial or complete vision loss

Dislocation can be diagnosed by physical exam, ocular ultrasound, computed tomography, or magnetic resonance imaging.2,3

The treatment includes ophthalmological consultation for surgical lens removal to avoid potential complications, such as ocular hypertonia, corneal decompensation, and inflammation.4

Master Clinician Bedside Pearls

Janak Acharya, MD FACEP 
University of California San Francisco – Fresno
Health Sciences Assistant Clinical Professor
Department of Emergency Medicine
Medical Director American Ambulance
Medical Director Skylife Air Ambulance

1.
Jarrett W. Dislocation of the lens. A study of 166 hospitalized cases. Arch Ophthalmol. 1967;78(3):289-296. [PubMed]
2.
Frasure S, Saul T, Lewiss R. Bedside ultrasound diagnosis of vitreous hemorrhage and traumatic lens dislocation. Am J Emerg Med. 2013;31(6):1002.e1-2. [PubMed]
3.
Eken C, Yuruktumen A, Yildiz G. Ultrasound diagnosis of traumatic lens dislocation. J Emerg Med. 2013;44(1):e109-10. [PubMed]
4.
Hafidi Z, Daoudi R. Images in clinical medicine. Anterior dislocation of the lens. N Engl J Med. 2014;370(14):1343. [PubMed]
Jeff Riddell, MD

Jeff Riddell, MD

ALiEM Assistant Editor
Diagnose on Sight series;
Medical Education Research Fellow
University of Washington / Harborview Medical Center
Jeff Riddell, MD

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