Ocular Ultrasound—Point of Care Imaging of the Eye

A Narrative Review of Common Uses of Ophthalmic Ultrasound in Emergency Medicine

BACKGROUND

The timely evaluation of ocular conditions in the emergency department (ED) can be difficult due to a general lack of specialized equipment, trained personnel, and the time-sensitive nature of emergent ocular conditions. Recently, the use of ocular point-of-care ultrasound (POCUS) has been shown to be particularly useful in the ED. POCUS can be used to promptly diagnose various ocular pathologies, which include ocular trauma, vitreous hemorrhage, central retinal artery occlusion, and retinal detachment.

OBJECTIVES

This narrative review seeks to inform the reader of current literature regarding the use of POCUS for the assessment of various ocular emergencies in the ED. The goal of this review is to provide the emergency physician with succinct and up-to-date information and instruction regarding the current uses of POCUS for patients presenting with particular ocular emergencies. Ocular pathologies that are common (ocular trauma) or for which ultrasound is particularly useful (such as retinal detachment) are discussed. Other ocular pathologies are also briefly discussed, such as central retinal artery occlusion, which is a promising new application for ultrasound evaluation.

DISCUSSION

There have been many studies that provide evidence for the utility of POCUS in the evaluation of trauma and other ocular pathologies, including vitreous hemorrhage, retinal detachment, and central retinal artery occlusion.

CONCLUSIONS

Ocular POCUS is a useful modality in the evaluation of acute ocular complaints in the ED. Emergency physicians should be aware of these findings and feel confident in the utility of ocular POCUS in the ED.

Ultrasonographic assessment of paediatric ocular emergencies: A tertiary eye hospital based observation

BACKGROUND

The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the first point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies.

METHODS

A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids.

RESULTS

Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80 (65.57%) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage (8.19%), retinal detachment (6.55%), choroidal detachment (4.91%), posteriorly dislocated clear lens (0.81%) and retained intraocular foreign body (5.73%). Non-traumatic cases constituted around 42 (34.42%) eyes, which included corneal ulcer (7.37%), retinoblastoma (6.55%), endophthalmitis (4.91%), extra-ocular muscle cysticercosis (4.91%), orbital cellulitis (4.09%), periocular haemorrhage (2.45%), proptosis(1.63%), paediatric cataract (1.63%) and cryptophthalmos (0.81%). No adverse events of performing the ultrasound was noted.

CONCLUSION

First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of significant posterior segment and orbital diseases.