This patient has a normal retina and optic nerve, but appears to have a lens dislocation in the L eye along with some hyperechoic debris in the posterior chamber which may represent vitreous hemorrhage vs scar tissue.
Lens Dislocation
Lens dislocation or ectopia lentis, is a rare condition characterized by a displacement of the lens of the eye. If the lens lies completely outside of the lens patellar fossa, then it is dislocated or luxated. Lens subluxation is definied as a partially displaced lens which stil lies in the lens space. The dislocation of the lens results from the disruption of the zonular fibers of the lens and the degree of disruption is proportional to the degree of lens displacement.
The most common cause of lens dislocation is trauma, but it can also be congential. It is also associated with Marfan's, homocystinuria, Weil-Marchesani, sulfite oxidase deficiency, and hyperlysinemia. Patients with lens dislocations usually complain of varying degrees of decreased visual accuity depending if it is a partial or complete dislocation. In trauma patients, be aware that other ocular signs of trauma may also be present such as retinal detachment, vitreous hemorrhage or globe rupture.
On Ultrasound, the lens is normally located posterior to the iris and anterior chamber and appears as a hyperechoic or white line. When it is dislocated, the lens will appear as an ovoid structure floating in the posterior chamber. Be sure to evaluate the eye with the patient looking straight ahead first, then with the eyes looking medial and lateral. This allows visualization of the entire eye.