In a sneak peek of my ACEP News’ Tricks of the Trade column, Dr. Patrick Lenaghan, Dr. Ralph Wang, and I will discuss how bedside ultrasonography can significantly improve your ocular exam.

Here is a classic example. A patient presents with acute onset right eye pain and blurry vision. She possibly has a field cut in her vision. Her pupils are a teeny 2 mm in size in the brightly-lit Emergency Department. You are having a hard time getting a good fundoscopic exam to comfortably rule-out a retinal detachment.

Trick of the trade: Ocular ultrasonography to diagnose retinal detachment

Apply a generous amount of gel on the patient’s closed eyelid, such that the probe does not contact the patient’s eyelid. Position a linear high-frequency ultrasound probe on the patient’s upper eyelid.

  • Vitreous fluid and the lens are anechoic (black).
  • The ciliary bodies and retina are hyperechoic (white).

A retinal detachment appears as a hyperechoic stripe (yellow arrow) adherent to the retina.

Image courtesy of Dr. Patrick Lenaghan

Image courtesy of Dr. Patrick Lenaghan

Important Note

If the patient may potentially have a globe rupture, ocular ultrasonography is relatively contraindicated. Do not apply any pressure to the patient’s orbit.

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD