Ocular Ultrasound

  • Brian Patrick Murray


The use of point-of-care ultrasound in the emergency department, as well as in the intensive care unit and in outpatient clinics, has exploded in the last few years due largely to point-of-care ultrasound’s low cost, ease of use, and ability to answer specific questions in a timely manner. Its use is particularly helpful in the undifferentiated patient, in whom there is a change in vision, where it may quickly and effectively augment or even replace the fundoscopic exam. This chapter reviews the common applications of the ocular point-of-care ultrasound exam, and it covers the basics of how to perform an ultrasound examination as well as normal and common pathologic states.


Point-of-care Ultrasound Ocular Ultrasound safety Lens dislocation Retinal detachment Vitreous detachment Vitreous hemorrhage Endophthalmitis Optic nerve sheath diameter 


  1. 1.
    Sharma R, Brunette DD. Rosen’s emergency medicine concepts and clinical practice. 8th ed. Philadelphia, PA: Saunders; 2014. p. 909. Chapter 71.Google Scholar
  2. 2.
    Romaniuk VM. Ocular trauma and other catastrophes. Emerg Med Clin North Am. 2013;31(2):399–411.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Colby K. Management of open globe injuries. Int Ophthalmol Clin. 1999;39(1):59–69.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Rocha KM, Martins EN, Melo LA Jr, et al. Outpatient management of traumatic hyphema in children: prospective evaluation. J AAPOS. 2004;8(4):357–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Wu EH, et al. Self-confidence in and perceived utility of the physical examination: a comparison of medical students, residents, and faculty internists. J Gen Intern Med. 2007;22(12):1725–30.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ritchie JV, Horne ST, Perry J, Gay D. Ultrasound triage of ocular blast injury in the military emergency department. Mil Med. 2012;177(2):174–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Gay DAT, et al. Ultrasound of penetrating ocular injury in a combat environment. Clin Radiol. 2013;68(1):82–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Russell TC, Crawford PF. Ultrasound in the austere environment: a review of the history, indications, and specifications. Mil Med. 2013;178(1):21–8.CrossRefPubMedGoogle Scholar
  9. 9.
    American College of Emergency Physicians. Policy Statement on Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine, June 2016.,-Point-of-care,-and-Clinical-Ultrasound-Guidelines-in-Medicine/?__taxonomyid=471332. Accessed 5 Nov 2018.
  10. 10.
    Bedi DG, Gombos DS, Ng CS, Singh S. Sonography of the eye. AJR Am J Roentgenol. 2006;187(4):1061–72.CrossRefPubMedGoogle Scholar
  11. 11.
    Blaivas M, Theodoro D, Sierzenski PR. A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med. 2002;9(8):791–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Bioeffects Committee of the American Institute of Ultrasound in Medicine. American Institute of Ultrasound in Medicine consensus report on potential bioeffects of diagnostic ultrasound executive summary. J Ultrasound Med. 2008;27(4):503–15.CrossRefGoogle Scholar
  13. 13.
    Duck FA. Hazards, risks and safety of diagnostic ultrasound. Med Eng Phys. 2008;30(10):1338–48.CrossRefPubMedGoogle Scholar
  14. 14.
    Hershkovitz R, Sheiner E, Mazor M. Ultrasound in obstetrics: a review of safety. Eur J Obstet Gynecol Reprod Biol. 2002;101(1):15–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Barnett SB, Ter Haar GR, Ziskin MC, Rott HD, Duck FA, Maeda K. International recommendation and guidelines for the safe use of diagnostic ultrasound in medicine. Ultrasound Med Biol. 2000;26:355–66.CrossRefPubMedGoogle Scholar
  16. 16.
    Palte HD, Gayer S, Arrieta E, et al. Are ultrasound-guided ophthalmic blocks injurious to the eye? A comparative rabbit model study of two ultrasound devices evaluating intraorbital thermal and structural changes. Anesth Analg. 2012;115(1):194–201.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Silverman RH, Lizzi FL, Ursea BG, et al. Safety levels for exposure of cornea and lens to very high-frequency ultrasound. J Ultrasound Med. 2001;20(9):979–86.CrossRefPubMedGoogle Scholar
  18. 18.
    Nelson TR, Fowlkes JB, Abramowicz JS, Church CC. Ultrasound biosafety considerations for the practicing sonographer and sonologist. J Ultrasound Med. 2009;28(2):139–50.CrossRefPubMedGoogle Scholar
  19. 19.
    Park DJ, Karesh JW. Topographic anatomy of the eye: an overview. In: Duane’s foundations of clinical ophthalmology. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.Google Scholar
  20. 20.
    Roth KR, Gafni-Pappas G. Unique method of ocular ultrasound using transparent dressings. J Emerg Med. 2011;40(6):658–60.CrossRefPubMedGoogle Scholar
  21. 21.
    Adhikari SR. Sonoguide website at: Accessed 4 Aug 2016.
  22. 22.
    Kilker BA, Holst JM, Hoffmann B. Bedside ocular ultrasound in the emergency department. Eur J Emerg Med. 2014;21(4):246–53.CrossRefPubMedGoogle Scholar
  23. 23.
    D’Amico DJ. Clinical practice. Primary retinal detachment. N Engl J Med. 2008;359(22):2346–54.CrossRefPubMedGoogle Scholar
  24. 24.
    Teismann N, Shah S, Nagdev A. Focus on: ultrasound for acute retinal detachment. Irving, TX: ACEP News; 2009.Google Scholar
  25. 25.
    Yoonessi R, Hussain A, Jang TB. Bedside ocular ultrasound for the detection of retinal detachment in the emergency department. Acad Emerg Med. 2010;17(9):913–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Shinar Z, Chan L, Orlinsky M. Use of ocular ultrasound for the evaluation of retinal detachment. J Emerg Med. 2011;40(1):53–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Jacobsen B, Lahham S, Lahham S, Patel A, Spann S, Fox JC. Retrospective review of ocular point-of-care ultrasound for detection of retinal detachment. West J Emerg Med. 2016;17(2):196–200.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Imran S, Amin S, Daula MI. Imaging in ocular trauma optimizing the use of ultrasound and computerised tomography. Pak J Ophthalmol. 2011;27(3):146–51.Google Scholar
  29. 29.
    Ido M, Osawa S, Fukukita M, et al. The use of colour Doppler imaging in the diagnosis of retinal detachment. Eye (Lond). 2007;21(11):1375–8.CrossRefGoogle Scholar
  30. 30.
    Jarrett WH. Dislocation of the lens. A study of 166 hospitalized cases. Arch Ophthalmol. 1967;78:289–96.CrossRefPubMedGoogle Scholar
  31. 31.
    Nelson LB, Maumenee IH. Ectopia lentis. Surv Ophthalmol. 1982;27(3):143–60.CrossRefPubMedGoogle Scholar
  32. 32.
    Frasure SE, Saul T, Lewiss RE. Bedside ultrasound diagnosis of vitreous hemorrhage and traumatic lens dislocation. Am J Emerg Med. 2013;31(6):1002.e1–2.CrossRefGoogle Scholar
  33. 33.
    Ojaghi Haghighi SH, Morteza Begi HR, Sorkhabi R, et al. Diagnostic accuracy of ultrasound in detection of traumatic lens dislocation. Emerg (Tehran). 2014;2(3):121–4.Google Scholar
  34. 34.
    Eken C, Yuruktumen A, Yildiz G. Ultrasound diagnosis of traumatic lens dislocation. J Emerg Med. 2013;44(1):e109–10.CrossRefPubMedGoogle Scholar
  35. 35.
    Leo M, Carmody K. Sonography assessment of acute ocular pathology. Ultrasound Clin. 2011;6(2):227–34.CrossRefGoogle Scholar
  36. 36.
    Rabinowitz R, Yagev R, Shoham A, Lifshitz T. Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage. Eye (Lond). 2004;18(3):253–6.CrossRefGoogle Scholar
  37. 37.
    Kohanim S, Daniels AB, Huynh N, Eliott D, Chodosh J. Utility of ultrasonography in diagnosing infectious endophthalmitis in patients with media opacities. Semin Ophthalmol. 2012;27:242–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Girisgin AS, Kalkan E, Kocak S, Cander B, Gul M, Semiz M. The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure. Emerg Med J. 2007;24(4):251–4.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Potgieter DW, Kippin A, Ngu F, McKean C. Can accurate ultrasonographic measurement of the optic nerve sheath diameter (a non-invasive measure of intracranial pressure) be taught to novice operators in a single training session? Anaesth Intensive Care. 2011;39(1):95–100.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Sekhon MS, McBeth P, Zou J, et al. Association between optic nerve sheath diameter and mortality in patients with severe traumatic brain injury. Neurocrit Care. 2014;21(2):245–52.CrossRefPubMedGoogle Scholar
  41. 41.
    Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg. 1997;87(1):34–40.CrossRefPubMedGoogle Scholar
  42. 42.
    Qayyum H, Ramlakhan S. Can ocular ultrasound predict intracranial hypertension? A pilot diagnostic accuracy evaluation in a UK emergency department. Eur J Emerg Med. 2013;20(2):91–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Stone MB. Ultrasound diagnosis of papilledema and increased intracranial pressure in pseudotumor cerebri. Am J Emerg Med. 2009;27(3):376.e1–2.CrossRefGoogle Scholar
  44. 44.
    Hassen GW, Bruck I, Donahue J, et al. Accuracy of optic nerve sheath diameter measurement by emergency physicians using bedside ultrasound. J Emerg Med. 2015;48(4):450–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Rifenburg RP, Williams JJ. Optic nerve head drusen: a case of false-positive papilledema discovered by ocular ultrasound in the emergency department. Crit Ultrasound J. 2010;2(2):75–6.CrossRefGoogle Scholar
  46. 46.
    Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension II. Patient study. Pediatr Radiol. 1996;26(10):706–10.CrossRefPubMedGoogle Scholar
  47. 47.
    Newman WD, Hollman AS, Dutton GN, Carachi R. Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol. 2002;86(10):1109–13.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003;10(4):376–81.CrossRefPubMedGoogle Scholar
  49. 49.
    Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med. 2007;49(4):508–14.CrossRefPubMedGoogle Scholar
  50. 50.
    Geeraerts T, Launey Y, Martin L, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med. 2007;33(10):1704–11.CrossRefPubMedGoogle Scholar
  51. 51.
    Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J. Noninvasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Crit Care. 2008;12(2):1.Google Scholar
  52. 52.
    Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care. 2008;12(3):R67.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. 2008;15(2):201–4.CrossRefPubMedGoogle Scholar
  54. 54.
    Goel RS, Goyal NK, Dharap SB, Kumar M, Gore MA. Utility of optic nerve ultrasonography in head injury. Injury. 2008;39(5):519–24.CrossRefPubMedGoogle Scholar
  55. 55.
    Moretti R, Pizzi B. Optic nerve ultrasound for detection of intracranial hypertension in intracranial hemorrhage patients. J Neurosurg Anesthesiol. 2009;21(1):16–20.CrossRefPubMedGoogle Scholar
  56. 56.
    Ballantyne SA, O’Neill G, Hamilton R, Hollman AS. Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound. 2002;15(3):145–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Major R, Girling S, Boyle A. Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure. Emerg Med J. 2011;28(8):679–81.CrossRefPubMedGoogle Scholar
  58. 58.
    Bäuerle J, Nedelmann M. Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension. J Neurol. 2011;258(11):2014–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Frumin E, Schlang J, Wiechmann W, et al. Prospective analysis of single operator sonographic optic nerve sheath diameter measurement for diagnosis of elevated intracranial pressure. West J Emerg Med. 2014;15(2):217–20.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Caffery TS, Perret JN, Musso MW, Jones GN. Optic nerve sheath diameter and lumbar puncture opening pressure in nontrauma patients suspected of elevated intracranial pressure. Am J Emerg Med. 2014;32(12):1513–5.CrossRefPubMedGoogle Scholar
  61. 61.
    Maissan IM, Dirven PJAC, Haitsma IK, Hoeks SE, Gommers D, Stolker RJ. Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. J Neurosurg. 2015;123(3):743–7.CrossRefPubMedGoogle Scholar
  62. 62.
    Komut E, Kozacı N, Sönmez BM, Yılmaz F, Komut S, Yıldırım ZN, Beydilli İ, Yel C. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in ED. Am J Emerg Med. 2016;34(6):963–7.CrossRefPubMedGoogle Scholar
  63. 63.
    Kazdal H, Kanat A, Findik H, et al. Transorbital ultrasonographic measurement of optic nerve sheath diameter for intracranial midline shift in patients with head trauma. World Neurosurg. 2016;85:292–7.CrossRefPubMedGoogle Scholar
  64. 64.
    Moretti R, Pizzi B, Cassini F, Vivaldi N. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care. 2009;11(3):406–10.CrossRefPubMedGoogle Scholar
  65. 65.
    Beare NAV, Kampondeni S, Glover SJ, et al. Detection of raised intracranial pressure by ultrasound measurement of optic nerve sheath diameter in African children. Tropical Med Int Health. 2008;13(11):1400–4.CrossRefGoogle Scholar
  66. 66.
    Malayeri AA, Bavarian S, Mehdizadeh M. Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med. 2005;24(2):143–7.CrossRefPubMedGoogle Scholar
  67. 67.
    Ballantyne J, Hollman AS, Hamilton R, Bradnam MS, Carachi R, Young DG, Dutton GN. Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol. 1999;54(11):740–2.CrossRefPubMedGoogle Scholar
  68. 68.
    Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Pershad J. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. Ann Emerg Med. 2009;53(6):785–91.CrossRefPubMedGoogle Scholar
  69. 69.
    Moretti R, Pizzi B. Ultrasonography of the optic nerve in neurocritically ill patients. Acta Anaesthesiol Scand. 2011;55(6):644–52.CrossRefPubMedGoogle Scholar
  70. 70.
    Chiao L, Sharipov S, Sargsyan AE, Melton S, Hamilton DR, McFarlin K, Dulchavsky SA. Ocular examination for trauma; clinical ultrasound aboard the International Space Station. J Trauma Acute Care Surg. 2005;58(5):885–9.CrossRefGoogle Scholar
  71. 71.
    Harries A, Shah S, Teismann N, Price D, Nagdev A. Ultrasound assessment of extraocular movements and pupillary light reflex in ocular trauma. Am J Emerg Med. 2010;28(8):956–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Brian Patrick Murray
    • 1
  1. 1.Emergency Medicine, Brooke Army Medical CenterSan AntonioUSA

Personalised recommendations