Bedside Ocular Ultrasound

Orbital Mass Identified With Point-of-Care Ultrasound in a Child Presenting With Eyelid Swelling

ABSTRACT

Point-of-care ultrasound was used in a child presenting to the emergency department with progressively worsening left eyelid swelling. The early use of ultrasound was helpful in detecting a soft tissue mass that is exhibiting pressure effect on the eyeball. Point-of-care ultrasound helped expedite advanced imaging and consultation with the specialist. The patient eventually had a biopsy and was diagnosed with idiopathic orbital inflammation.

Traumatic Orbital Compression Syndromes: A Comprehensive Study Into Etiologies, Intervention Strategies, and Clinical Outcomes

Facial fractures and their historical link to potential blindness have been well-documented, often attributed to optic canal injuries or retinal vascular occlusion. This dire consequence can result from both direct and indirect ocular trauma, including retrobulbar hemorrhage. Traumatic orbital compression can manifest in various forms, such as hematomas, fractured bone fragments, and emphysema, all posing a significant threat to vision, necessitating immediate intervention. In this study, 9 clinical cases of traumatic orbital compression are presented, each characterized by distinct etiologies. The study delves into traumatic orbital compressive syndromes, underscoring the critical imperative of early recognition and treatment to prevent vision loss. Orbital compression, whether from edema, hematoma, or emphysema, collectively culminates in elevated intraorbital pressure and the potential for optic nerve ischemia. Through the presentation of these 9 clinical cases, the article emphasizes the pressing need for timely intervention in addressing orbital compressive syndromes to avert vision loss. Various surgical techniques are elucidated, highlighting the pivotal role of expeditious medical intervention. This article offers invaluable insights into the diagnosis, management, and outcomes of traumatic orbital compressive syndromes.

Utility of High-Resolution Ultrasonography in the Evaluation of Posterior Segment Ocular Lesions Using Sensitivity and Specificity

Background

High-resolution Ultrasound (USG) provides good anatomical details of the ocular posterior segment and depicts the various pathological conditions affecting the ocular posterior segment, which helps ophthalmologists for choosing the best treatment options. This study aims to evaluate the utility of High-resolution Ultrasonography in the Evaluation of Posterior Segment Ocular lesions by using Sensitivity and Specificity.

Materials and Methods

A hospital-based retrospective study enrolled 81 patients in a tertiary care hospital. Clinical and ophthalmological examinations were performed followed by USG of the orbits. B-mode USG was done with a 7.5-13 MHz linear probe. The final diagnosis was made by correlating the USG findings with clinical and ophthalmological examinations.

Statistical analysis

Sensitivity, specificity, the positive predictive value, the negative predictive value, and the accuracy of B-scan USG were compared with the ophthalmological findings by using the Chi-square test.

Results

Of 81 patients (n=48 males and n=33 females) with a mean age of 38.98 ± 16.48 [SD] years, posterior segment ocular lesions in association with cataracts were found in 27 (33.3%) patients, whereas 14 (51.9%) patients had posterior vitreous detachment (PVD), 10 (37%) patients had retinal detachment (RD), and 1 (3.7%) patient had choroidal detachment (CD). Posterior segment ocular pathologies were found in 17 (21%) patients with blunt ocular injuries, whereas 8 (47.1%) patients had PVD, 4 (23.5%) patients had RD and 4 (23.5%) patients had CD. The ocular USG had a sensitivity of 87.32%, specificity of 80%, and accuracy of 86.42% with a statistically significant difference between the USG findings and the Ophthalmology diagnosis of the posterior segment ocular abnormalities of a p-value of 0.0005.

Conclusion

High-resolution ultrasound is one of the best and an easily available imaging modality for the evaluation of posterior segment ocular pathologies, especially in the presence of opaque ocular media.

Detection of Central Retinal Artery Occlusion by Point-of-Care Ultrasound in the Emergency Department: A Case Series

Central retinal artery occlusion (CRAO) is a rare, but serious, diagnosis that can lead to blindness, most often due to thromboembolic disease. In the emergency department (ED), CRAO can present as acute, painless loss of vision. Physicians need quick ways to rule in this diagnosis due to the time-sensitive nature of the event. We describe two patients in this cases series who present to the same ED with unilateral painless vision loss and histories that include notable risk factors such as thromboembolic and atherosclerotic disease. Upon arrival, point-of-care ultrasound (POCUS) done at the bedside allowed for quick determination of CRAO. ​​​​​​​The importance of this case series is to emphasize the efficacy of POCUS in evaluating patients with painless vision loss in the ED setting. 

Bedside Ocular Ultrasound Diagnosis of a Traumatic Lens Dislocation

Rapid identification of ophthalmologic emergencies can be challenging in the ED, and a missed or delayed diagnosis may have vision-threatening consequences. The application of ocular point-of-care ultrasound (POCUS) by the emergency physician (EP) can facilitate the timely recognition of a myriad of emergent eye conditions. This report describes a case in which EP-performed POCUS established the prompt diagnosis of a traumatic lens dislocation in a patient with chronic vision changes.

Point of care ultrasound and ocular injuries: A case of lens dislocation and a comprehensive review of the literature

Point-of-care ultrasound (POCUS) can help the clinician diagnose different ocular pathologies including retinal detachment, vitreous detachment, lens dislocation, and intraocular foreign bodies. Ocular pathologies such as blurry vision, double vision, loss of vision, and eye trauma are common chief complaints and require a comprehensive evaluation in order to determine the etiology and choose the correct treatment. Specifically ultrasound can help the clinician decide whether an urgent ophthalmology consult is appropriate. We present a case in which a lens dislocation was diagnosed using POCUS and review the available literature.

Emergency Ocular Ultrasound - Common Traumatic and Non-Traumatic Emergencies Diagnosed with Bedside Ultrasound

Point-of-care ocular ultrasound (POCOUS) in the ambulatory and critical care setting has become an invaluable diagnostic tool for patients presenting with traumatic or atraumatic vision and ocular complaints. Sonographic bedside evaluation is intuitive and easy to perform and can accurately diagnose a variety of pathologies. These include detachment or hemorrhage of the retina or vitreous, lens dislocation, retrobulbar hematoma or air, as well as ocular foreign bodies, infections, tumors, and increased optic nerve sheath diameter that can be assessed in the setting of suspected increased intracranial pressure. The ocular anatomy is easy to visualize with sonography, as the eye is a superficial structure filled with fluid. Over the last two decades, a large number of scientific publications have documented that POCOUS in emergent or critical care settings is an accurate diagnostic tool and expands and improves emergency diagnosis and management. This article will review POCOUS exam techniques as well as normal sonographic findings and common pathologies.

A Proposal for a New Protocol for Sonographic Assessment of the Optic Nerve Sheath Diameter: The CLOSED Protocol

Measuring and monitoring of intracranial pressure is considered standard of care in patients with suspected intracranial hypertension. Sonographic assessment of the optic nerve sheath diameter (ONSD) has been promising and potentially useful for noninvasive intracranial hypertension screening. ONSD measurements are easy to perform, repeatable at bedside, fast, low cost, and radiation-free. However, they are still burdened by inter-rater variability, lack of ultrasound (US) setting standardization (e.g., US frequency, focus depth, etc.), and possible artifacts. To overcome this problem, we propose the CLOSED protocol associated with equipment specifications, as a guide to minimize the occurrence of such artifacts enabling a more reliable and accurate measurement. We suggest that color Doppler could be used as a new standard evaluation for the ONSD.

Role Of Point Of Care Ultrasound In The Diagnosis Of Retinal Detachment In The Emergency Department

Ocular complaints represent up to 3% of all emergency department (ED) visits. These presentations can result in permanent vision loss if not promptly diagnosed and treated. Recently, point of care ultrasound (POCUS) has been investigated for the evaluation of ocular pathology in the ED. Multiple studies have investigated the role that ultrasound may play in the early diagnosis of these patients. Ocular ultrasound can be used to visualize the structures of the eye and evaluate for pathology such as retinal detachment, vitreous hemorrhage and vitreous detachment. This comprehensive review aims to present current evidence for the efficacy and reliability of ED ocular ultrasound use in the detection of retinal detachment and additional ocular pathologies.

Ocular surface heat effects on ocular hemodynamics detected by real-time measuring device

AIM

To investigate the ocular hemodynamic effects of applying a hot compress to the eye.

METHODS

The right eyes of five New Zealand white rabbits, both male and female, were hot-compressed for 18min. An independently designed novel ocular contact-type temperature measuring device was used to measure the ocular surface temperature before and after the heating. Relevant retrobulbar hemodynamic parameters such as peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) of each of the central retinal artery (CRA), long posterior ciliary artery (LPCA), and ophthalmic artery (OA), as well as the mean velocity (V_m) of the central retinal vein (CRV), were measured using a color Doppler flow imaging (CDFI) technique and expressed as mean values with standard deviation (mean±SD). A statistical analysis was conducted based on a paired t-test and the Wilcoxon signed-rank test.

RESULTS

The employed real-time temperature measuring device was able to accurately measure ocular surface temperature during the hot-compress process. The temperature increased after the hot compress was applied. Analysis showed that the PSV and EDV values of the CRA and LPCA significantly increased after the application of the hot compress, as did the V_m of the CRV. There were no significant changes in the EDV of the OA nor the RI of each artery.

CONCLUSION

This experiment, which is the first of its kind, confirms that the retrobulbar blood flow velocities can increase upon heating the ocular surface. This simple method may be useful in the future.

Child With Red Eye and Blurry Vision

Point-of-care ocular ultrasound can provide the clinician with more information about potential intraorbital and extraocular pathology, especially in cases when direct visualization of the eye is limited. This case report describes the findings in a pediatric patient who presented with a 1-month history of eye injection and worsening blurry vision. After point-of-care ultrasound demonstrated abnormal debris in the posterior vitreous cavity, subsequent evaluation revealed a diagnosis of pars planitis.

Choroid Detachment, a Rare Cause of Vision Loss Diagnosed by Point-of-Care Ultrasound

BACKGROUND

Choroid detachment is a rare disease process that has a multitude of etiologies; usually related to recent ophthalmological surgery, eye trauma, corneal ulcers, or intraocular pressure-lowering agents. Point-of-care ocular ultrasound has high utility and accuracy in diagnosing pathology of the eye.

CASE REPORT

We present a case of a patient who presented with vision loss caused by a choroid detachment diagnosed on point-of-care ultrasound because fundoscopic examination was limited due to cataracts. Ultrasound findings based on location and appearance during both static and dynamic evaluation that help differentiate a choroid vs. a retinal detachment are also described. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Choroid detachments have a different sonographic appearance, as well as management, compared to a retinal detachment.

Ocular ultrasonography focused on the posterior eye segment: what radiologists should know

Abstract

Ocular B-mode ultrasonography (US) is an important adjuvant for the clinical assessment of a variety of ocular diseases. When ophthalmoscopy is not possible, mainly due to opacification of the transparent media (e.g., mature cataract or vitreous haemorrhage), US can guide the ophthalmologist in diagnosing disease and choosing treatment. The superficial location and cystic structure of the eye make US ideal for imaging of the eye. Moreover, dynamic study helps distinguish between various conditions that would otherwise be difficult to differentiate in some clinical setting, such as vitreous, retinal, and choroidal detachment. US is also good technique for detecting other pathologic conditions such as lens dislocation, vitreous haemorrhage, asteroid hyalosis, optic disc drusen, and tumors (e.g., choroidal melanoma, metastases, hemangioma). An understanding of the basic anatomy of the eye, the US technique, and common entities that affect the ocular globe will allow radiologists to offer this valuable imaging modality to patients and referring clinicians. This article focuses on the US anatomy and pathologic conditions that affect the posterior ocular segment.

Teaching points

• US is specially indicated when ocular fundus cannot be assessed on ophthalmoscopy.

• Multipurpose equipment with high-frequency transducers is optimal for imaging the eye.

• Ultrasound can reliably depict ocular anatomy and pathology as detachments and tumours.

• Dynamic examination is vital for distinguishing certain pathologic conditions as detachments.

Electronic supplementary material

The online version of this article (doi:10.1007/s13244-016-0471-z) contains supplementary material, which is available to authorized users.

Emergency Point-of-Care Ultrasound Detection of Cancer in the Pediatric Emergency Department

The use of point-of-care ultrasound in the pediatric emergency department is evolving beyond conventional applications as users become more expert with the technology. In this case series, we describe the potential utility of recognizing abnormal anatomy to impact care in the context of possible cancer in pediatric patients. We describe 4 patients with Langerhans histiocytosis, neuroblastoma, Wilms tumor, and rhabdomyosarcoma, in which point-of-care ultrasound was used to facilitate the diagnoses.