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<br /> Ultrasound<br /> Point-of-care ocular ultrasound<br /> Philips tutorial<br /> Michael Blaivas, MD, FACEP, FAIUM<br /> Professor of Medicine<br /> University of South Carolina School of Medicine<br /> Department of Emergency Medicine<br /> St. Francis Hospital, Columbus, GA<br /> Contents<br /> Point-of-care ocular ultrasound<br /> 1 Introduction 3<br /> 2 Indications 5<br /> 3 Clinical anatomy 8<br /> 4 Technique 11<br /> 5 Ultrasound findings 14<br /> 6 Clinical pearls 24<br /> 7 Additional images and videos 28<br /> 8 Summary 37<br /> 9 References 38<br /> Additional resources 39<br /> 2 <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 1" href="http://viewer.zmags.com/publication/a9f9d2f9?page=1"> Ultrasound Point-of-care ocular ultrasound Phili</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 2" href="http://viewer.zmags.com/publication/a9f9d2f9?page=2"> Contents Point-of-care ocular ultrasound 1 </a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 3" href="http://viewer.zmags.com/publication/a9f9d2f9?page=3"> 1 Introduction In most emergency settings, th</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 4" href="http://viewer.zmags.com/publication/a9f9d2f9?page=4"> Ocular sonography has been employed by ophthalmol</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 5" href="http://viewer.zmags.com/publication/a9f9d2f9?page=5"> 2 Indications The primary indications for ocul</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 6" href="http://viewer.zmags.com/publication/a9f9d2f9?page=6"> Acute eye pain Pain, not related to trauma, can o</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 7" href="http://viewer.zmags.com/publication/a9f9d2f9?page=7"> Suspected elevation in intracranial pressure (ICP</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 8" href="http://viewer.zmags.com/publication/a9f9d2f9?page=8"> 3 Clinical anatomy The eye or globe is an ovo</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 9" href="http://viewer.zmags.com/publication/a9f9d2f9?page=9"> The anterior segment, in turn, is divided into th</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 10" href="http://viewer.zmags.com/publication/a9f9d2f9?page=10"> The choroid is a thin, highly vascular membrane t</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 11" href="http://viewer.zmags.com/publication/a9f9d2f9?page=11"> 4 Technique As in all ultrasound applications,</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 12" href="http://viewer.zmags.com/publication/a9f9d2f9?page=12"> Endocavity transducers meet many of these require</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 13" href="http://viewer.zmags.com/publication/a9f9d2f9?page=13"> [Figure 3a and 3b] The orbit is filled with gel t</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 14" href="http://viewer.zmags.com/publication/a9f9d2f9?page=14"> 5 Ultrasound findings On ultrasound the globe</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 15" href="http://viewer.zmags.com/publication/a9f9d2f9?page=15"> [ Video 1 ] Normal-appea</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 16" href="http://viewer.zmags.com/publication/a9f9d2f9?page=16"> The three posterior layers of the normal eye (ret</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 17" href="http://viewer.zmags.com/publication/a9f9d2f9?page=17"> [Figure 5b] Subtle retinal detachment. </a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 18" href="http://viewer.zmags.com/publication/a9f9d2f9?page=18"> The optic nerve enters the eye posteriorly and ap</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 19" href="http://viewer.zmags.com/publication/a9f9d2f9?page=19"> The optic nerve sheath diameter (ONSD) is measure</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 20" href="http://viewer.zmags.com/publication/a9f9d2f9?page=20"> Setting the cutoff for adult ONSD at approximatel</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 21" href="http://viewer.zmags.com/publication/a9f9d2f9?page=21"> Arterial and venous structures of the eye are mos</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 22" href="http://viewer.zmags.com/publication/a9f9d2f9?page=22"> [Figure 8a] Blue and red signals are seen on colo</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 23" href="http://viewer.zmags.com/publication/a9f9d2f9?page=23"> Key points • The iris can be seen on ultrasound b</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 24" href="http://viewer.zmags.com/publication/a9f9d2f9?page=24"> 6 Clinical pearls Intraocular artifacts Artifac</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 25" href="http://viewer.zmags.com/publication/a9f9d2f9?page=25"> [Figure 9] In this example a subtle vitreous deta</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 26" href="http://viewer.zmags.com/publication/a9f9d2f9?page=26"> Optic nerve asymmetry While asymmetry of the left</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 27" href="http://viewer.zmags.com/publication/a9f9d2f9?page=27"> Increased intracranial pressure (ICP) Measurement</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 28" href="http://viewer.zmags.com/publication/a9f9d2f9?page=28"> 7 Additional images and videos [Figure 10a] I</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 29" href="http://viewer.zmags.com/publication/a9f9d2f9?page=29"> [Figure 11a] Image demonstrating a hyphema with c</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 30" href="http://viewer.zmags.com/publication/a9f9d2f9?page=30"> [Figure 12a] Image demonstrating a displaced lens</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 31" href="http://viewer.zmags.com/publication/a9f9d2f9?page=31"> [Figure 13] Image demonstrating a posterior eye m</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 32" href="http://viewer.zmags.com/publication/a9f9d2f9?page=32"> [ Video 2 ] Ultrasound o</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 33" href="http://viewer.zmags.com/publication/a9f9d2f9?page=33"> [ Video 3 ] Ultrasound o</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 34" href="http://viewer.zmags.com/publication/a9f9d2f9?page=34"> [ Video 4 ] Ultrasound d</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 35" href="http://viewer.zmags.com/publication/a9f9d2f9?page=35"> [ Video 5 ] Ultrasound d</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 36" href="http://viewer.zmags.com/publication/a9f9d2f9?page=36"> [ Video 6] Ultrasound de</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 37" href="http://viewer.zmags.com/publication/a9f9d2f9?page=37"> 8 Summary Ocular ultrasound can provide a q</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 38" href="http://viewer.zmags.com/publication/a9f9d2f9?page=38"> 9 References 1. Blaivas M, Theodoro D</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 39" href="http://viewer.zmags.com/publication/a9f9d2f9?page=39"> Additional resources Additional resources re</a> <a title="UltrasoundOcular_Tutorial_Zmag2_14_FNL page 40" href="http://viewer.zmags.com/publication/a9f9d2f9?page=40"> This paper reflects the opinion of the author, no</a>