Indications for Ocular Ultrasound
Ocular ultrasound is primarily indicated when direct visualization of the posterior segment is not possible due to media opacities, and for evaluation of ocular trauma, retinal detachment, vitreous hemorrhage, and other posterior chamber pathologies. 1
Primary Indications
1. Media Opacities
- Dense cataracts
- Vitreous hemorrhage
- Corneal opacities
- Any condition preventing adequate visualization of the posterior segment
2. Suspected Retinal Pathology
- Retinal detachment
- Vitreous detachment
- Retinal tears
- Evaluation of macular architecture when OCT is not possible
3. Ocular Trauma
- Assessment of globe integrity
- Detection of intraocular foreign bodies
- Evaluation of retinal, choroidal, or vitreous detachments
- Vitreous hemorrhage assessment 2
4. Posterior Segment Masses
- Choroidal melanoma
- Metastatic lesions
- Hemangiomas
- Other intraocular tumors 3
5. Orbital Pathology
- Orbital masses
- Inflammatory changes
- Assessment in cases of exophthalmos 4
Clinical Utility
Ocular ultrasound provides valuable diagnostic information in emergency settings where:
- Fundoscopic examination is technically difficult or impossible
- Rapid assessment is needed for vision-threatening conditions
- Dynamic evaluation is required to distinguish between various detachments (retinal, vitreous, choroidal) 5, 6
Diagnostic Performance
When performed by trained practitioners, ocular ultrasound demonstrates:
- 97% sensitivity and 92% specificity for retinal detachment detection 6
- Ability to differentiate between retinal detachment, posterior vitreous detachment, and vitreous hemorrhage
- Capacity to evaluate the anatomic status of the retina in the presence of vitreous hemorrhage or other media opacity 1
Potential Pitfalls
- Posterior vitreous detachment can be misdiagnosed as retinal detachment
- Vitreous hemorrhage may obscure underlying pathology
- Disc edema can produce false positive results for retinal detachment
- Requires technical skill and experience for reliable interpretation 5, 4
Advantages
- Non-invasive and well-tolerated
- No radiation exposure
- Real-time dynamic assessment
- Can be performed at bedside in emergency settings
- Particularly valuable when ophthalmoscopy is not possible 4, 3
Ocular ultrasound remains a critical diagnostic tool in ophthalmology and emergency medicine, providing essential information when direct visualization of ocular structures is compromised, helping guide appropriate and timely treatment decisions.