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