The Crescent Sign of Anterior Capsular Tear Detection Using Ultrasound Biomicroscopy

Purpose: To describe a novel imaging sign denoting anterior lenticular capsular tear using Ultrasound Biomicroscopy (UBM) in a case of trauma with obscured direct visualization Methods: A case report and literature review. Results: A 40-year-old intravenous drug user was presented to the emergency department after injuring his right eye with a used hypodermic needle four days previously. Slit-lamp examination revealed an intense anterior segment reaction with corneal edema, limiting the view to deeper structures. UBM allowed lens visualization, which demonstrated a crescent hyperechoic anterior sub-capsular shadow, which was not present in the fellow eye. As the anterior segment inflammation and corneal edema cleared with topical steroid treatment and antibiotic treatment, the traumatic cataract, posterior synechiae, and lens particles in the anterior chamber became evident. A review of published literature demonstrated a similar sign of crescent hyperechoic anterior sub-capsular shadow that has been documented in two previous cases with disrupted anterior capsules and lens-particle glaucoma. Conclusion: UBM can be used for assessing anterior lenticular integrity and may aid in diagnosing lenticular injuries where a direct view is impossible. Lens crescent sign is a UBM finding that suggests lenticular injuries.