59-year-old male with trauma. Diagnosis? • Xray of the Week
Figure 1. What are the important findings?
A: Sagittal CT image demonstrates the right posterior lens subluxation with the inferior portion of the lens displaced posteriorly into the vitreous humor (red arrow).
B: Sagittal CT image demonstrates the normal location of the left lens in the iris (green arrow).
A: Ultrasound showing deviation of the right lens margin posteriorly into the anechoic vitreous humor (red arrow). The contralateral margin remains fixed adjacent to the iris (yellow arrow).
B: Ultrasound demonstrates the normal location of the left lens in the iris (green arrow).
Lens subluxation also known as ectopia lentis is dislocation of the lens most commonly secondary to trauma due to disruption of zonular filaments. Non-traumatic lens subluxation can also occur in homocystinuria and connective tissue disorders such as Marfan’s syndrome and Weill-Marchesani syndrome . Patients with ectopia lentis typically present with visual acuity problems but can also present with eye pain if secondary to trauma . Anterior dislocation of the lens is serious as it may lead to angle-closure glaucoma [3,4].
Lens subluxation can be diagnosed by ultrasound which shows deviation of the lens (Fig. 3) [4,5]. Computed tomography is also an alternative method for lens subluxation which again can show deviation of the lens (Figs. 1, 2) . Radiography has no role in orbital injuries due to its lower sensitivity for soft tissues .
Treatment of ectopia lentis often is nonsurgical. However, surgery is required in cases of pupil block glaucoma and progressive lens subluxation . Surgical management usually includes a pars plana lensectomy along with a vitrectomy .
Chandra A, Charteris D. Molecular pathogenesis and management strategies of ectopia lentis. Eye (Lond). 2014;28(2):162-168. doi:10.1038/eye.2013.274
Olm LK, Langer FW, Haygert CJ. Crystalline Lens Subluxation Following Blunt Head Trauma. Acta Med Port. 2020;33(10):692. doi:10.20344/amp.12418
Dagi LR, Walton DS. Anterior axial lens subluxation, progressive myopia, and angle closure glaucoma: recognition and treatment of atypical presentation of ectopia lentis. J AAPOS. 2006;10(4):345-350. doi:10.1016/j.jaapos.2006.01.218
Kubal WS. Imaging of orbital trauma. Radiographics. 2008;28(6):1729-1739. doi:10.1148/rg.286085523
Boniface KS, Aalam A, Salimian M, Liu YT, Shokoohi H. Trauma-Induced Bilateral Ectopia Lentis Diagnosed with Point-of-Care Ultrasound. J Emerg Med. 2015;48(6):e135-e137. doi:10.1016/j.jemermed.2015.01.004
Sai Kilaru is a medical student at Central Michigan University College of Medicine and plans to pursue a residency in diagnostic radiology. Sai first realized his interest in radiology while he was conducting research in radiomics at the University of Michigan, where he graduated from in 2018 with a Bachelor of Science degree in Neuroscience. As he progressed through his third year of medical school, Sai realized the very important role that radiology has in medicine and decided to take on the challenge of diagnosing patients in the future. Sai is also a member of the Gold Humanism Honor Society and is involved with giving back to the community at a local free clinic as a medical assistant. In his spare time, Sai enjoys playing basketball, board games, spending time with friends, and exploring new restaurants.
Follow Sai Kilaru on Twitter @sai_kilaru
Kevin M. Rice, MD is the president of Global Radiology CME
Dr. Rice is a radiologist with Renaissance Imaging Medical Associates and is currently the Vice Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator.
Follow Dr. Rice on Twitter @KevinRiceMD