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High-Yield Ocular Ultrasound Applications in the ED, Part 2

By Katrina D’Amore, DO, MPH; Sarah Bolan, MD; and Nicole Yuzuk, DO | on April 17, 2019 | 0 Comment
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Figure 2: Place a Tegaderm film dressing over the patient’s closed eye, gently press out any pockets of air, and apply a copious amount of gel directly over the Tegaderm.

Figure 2: Place a Tegaderm film dressing over the patient’s closed eye, gently press out any pockets of air, and apply a copious amount of gel directly over the Tegaderm.

scan, the patient will have to move his or her eyes side to side and up and down to allow complete visualization of the posterior segment.

  • The orbit is a superficial structure. Therefore, a high-frequency linear transducer should be used.
  • For comfort and to prevent a mess, place a Tegaderm film dressing over the patient’s closed eye and gently press out any pockets of air. Remember, air is the enemy of ultrasound.
  • When performing ocular ultrasound, a copious amount of gel should be used, which will prevent contact of the transducer with the eyelid and minimize direct pressure. The gel can be applied directly over the Tegaderm (see Figure 2).
  • Figure 3: Transverse visualization of the orbit.

    Figure 3: Transverse visualization of the orbit.

    Visualize the orbit in both transverse (see Figure 3) and longitudinal planes. After scanning through, the patient should be asked to move his or her eye right to left and up and down. A combination of still images and dynamic scanning clips will best document your exam.

  • Repeat these steps on the unaffected eye.
  • Contraindications to the exam include high suspicion of globe rupture.
  • Always supplement your ocular POCUS exam with a visual acuity and intraocular pressure measurement for a well-rounded emergency eye exam.

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    References

    1. Parker C. Optic nerve sheath diameter: window to the soul? Broome Docs website. Accessed Feb. 15, 2019.
    2. Ohle R, McIsaac SM, Woo MY, et al. Sonography of the optic nerve sheath diameter for detection of raised intracranial pressure compared to computed tomography: a systematic review and meta-analysis. J Ultrasound Med. 2015;34:1285-1294.

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