Ultrasound now gives physicians the utility to evaluate patients who have experienced acute vision loss more efficiently and accurately. It gives providers the ability to see behind the superficial structures and assess the lens, retina, vitreous body, ocular nerve, and ocular vasculature for pathology. Some disease processes, such as retinal detachment or central retinal artery occlusion, need to be treated in a timely manner to prevent sequelae of disease; ultrasound gives us this ability. In addition to ocular pathology, using the same technique, we can evaluate for neurologic conditions such as increased intracranial pressure. This chapter will review indications for performing an ocular ultrasound, basic ocular anatomy, image acquisition, normal ultrasound anatomy, and interpretation of pathology.
KeywordsVitreous hemorrhage Retinal detachment Posterior vitreous detachment Retrobulbar hematoma Central retinal artery occlusion Increased intracranial pressure Optic neuritis
Normal ocular ultrasound. A normal eye will maintain its shape with a round cornea, anterior chamber, iris, lens, and posterior chamber. Adjust the depth to visualize the entire globe and optic nerve (MP4 2783 kb)
Vitreous hemorrhage. During dynamic movement of the eye, echogenic debris swirls in the posterior chamber of the eye (MP4 1951 kb)
Retinal detachment. Thick echogenic band posteriorly. With dynamic eye movements, you will see that the retina is attached to an area near the optic nerve and the ora serrata (MP4 2341 kb)
Posterior vitreous detachment. With increased gain the PVD will appear as a smooth, thin membrane. The echogenic material is freely mobile with dynamic movements of the eye (MP4 2235 kb)
Lens dislocation. With a complete dislocation, the lens is seen floating around in the posterior chamber with dynamic movements (MP4 101 kb)
Lens subluxation. The lens is in its normal location; however, notice the detachment from the ciliary body on the left with movement (MP4 2282 kb)
Foreign body. Hyperechoic material within the outer surface of the eye (MP4 1933 kb)
- 1.Lyon M, von Kuenssberg JD. Chapter 19: Ocular. In: Ma OJ, Mateer JR, Reardon RF, Joing SA, editors. Emergency ultrasound. 3rd ed. Beijing: McGraw-Hill Education; 2014. p. 569–86.Google Scholar
- 2.SonoSim Ultrasound Training Solution [Video]. Santa Monica, CA: SonoSim Inc.; 2017.Google Scholar
- 4.Nedelmann M, Graef M, Weinand F, Wassill K, Kaps M, Lorenz B, Tanislav C. Retrobulbar spot sign predicts thombolytic treatment effects and etiology in Central Retinal Artery Occlusion. Stroke. 2015; 46(8) 2322-2324. June 25, 2015. https://doi.org/10.1161/STROKEAHA.115.009839. Accessed 14 Apr 2017.