Hyphaema Hiding Disaster: CT + Ultrasound Unmask Globe and Lens Rupture in a Cat

Case Report of Ultrasonographic and Computed Tomography Findings of Presumed Traumatic Ocular Globe and Lens Rupture in a Cat

Julius Klever; Clara Koch; Maria-Christine Fischer

Background

Traumatic orbital injuries in cats often obscure posterior ocular structures with hyphaema, limiting direct ophthalmoscopic assessment. Cross-sectional imaging (ultrasound and CT) can reveal otherwise hidden pathology (e.g., globe rupture, lens capsule disruption), which influence prognosis and management, especially in bilaterally affected, blind patients.

Methods

A 5-year-old spayed domestic shorthair cat presented two weeks after unknown trauma with facial asymmetry, bilateral hyphaema, absent menace and pupillary/dazzle reflexes. After clinical and slit-lamp examinations, the cat underwent non-contrast head CT (0.75-mm slices) and transcorneal ocular ultrasonography (18 MHz) under general anaesthesia. Imaging focused on globe contour, intraocular contents, lens integrity/position, and periocular structures.

Results

CT identified extensive craniofacial fractures and bilateral hyphaema. The right globe had reduced rostro-caudal diameter with posterior flattening and heterogeneous hyperattenuating vitreous consistent with haemorrhage, supporting globe rupture. The left globe was ovoid; the lens was ill-defined, reduced in volume, caudally displaced into the vitreous, and hypoattenuating relative to normal, consistent with posterior lens luxation and capsule rupture; vitreous hyperattenuation indicated haemorrhage. Ultrasound corroborated CT: right globe irregularity with retrobulbar fluid and echogenic vitreous; left lens echo-heterogeneity with displacement into the vitreous; suspected anterior (right) and posterior (left) synechiae. Given bilateral vision loss and multisystem trauma, euthanasia was elected; histopathology was declined.

Limitations

Definitive confirmation of globe and lens rupture via histopathology was not obtained. Single-case nature, delayed presentation (two weeks post-trauma), and concurrent severe craniofacial injuries limit generalizability and preclude assessment of therapeutic outcomes.

Conclusions

In feline orbital trauma with obscured posterior segments, CT and ocular ultrasound are complementary and can strongly support diagnoses of globe rupture and lens capsule disruption/luxation when clinical visualization is limited by hyphaema. Recognizing these imaging patterns is crucial for prognostication and decision-making in severely injured, bilaterally affected cats.

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