Neurological Sciences

, Volume 40, Issue 12, pp 2447–2457 | Cite as

Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians

  • Piergiorgio LochnerEmail author
  • Marek Czosnyka
  • Andrea Naldi
  • Epameinondas Lyros
  • Paolo Pelosi
  • Shrey Mathur
  • Klaus Fassbender
  • Chiara Robba
Review Article



Estimation of intracranial pressure (ICP) may be helpful in the management of neurological critically ill patients. It has been shown that ultrasonography of the optic nerve sheath diameter (ONSD) is a reliable tool for non-invasive estimation of increased intracranial pressure (ICP) at hospital admission or in intensive care. Less is known about the estimation of increased ICP and usefulness of ONSD in the prehospital setting. The aim of this review was to elucidate both prevailing and novel applications of ONSD for neurologists and critical care physicians.


In this review, we discuss the technique and the novel approach of ONSD measurement, the clinical applications of ONSD in neurology and critical care patients.


ONSD measurement is simple, easy to learn, and has diverse applications. ONSD has utility for ICP measurement in intracranial hemorrhage and ischemic stroke, meningitis and encephalitis, and idiopathic intracranial hypertension (IIH). It is also valuable for lesser known syndromes, where an increase of ICP is postulated, such as acute mountain sickness and posterior reversible encephalopathy syndrome. ONSD changes develop in inflammatory or ischemic optic neuropathies. Some papers demonstrate the usefulness of ONSD studies in symptomatic intracranial hypotension.


ONSD is a safe and low-cost bedside tool with the potential of screening patients who need other neuroimaging and those who may need an invasive measurement of ICP.


Optic nerve sheath diameter (ONSD) Transorbital ultrasonography (TSO) Optic nerve Symptomatic intracranial hypotension (SIH) Intracranial pressure (ICP) Acute mountain sickness (AMS) 


Compliance with ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of NeurologySaarland University Medical CenterHomburgGermany
  2. 2.Division of Neurosurgery, Department of Clinical NeurosciencesCambridge UniversityCambridgeUK
  3. 3.Department of Neurosciences “Rita Levi Montalcini”University of TurinTurinItaly
  4. 4.Anesthesia and Intensive Care, San Martino Policlinico HospitalIRCCS for Oncology and NeurosciencesGenoaItaly
  5. 5.Department of Surgical Sciences and Integrated DiagnosticsUniversity of GenoaGenoaItaly

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