Part 2 book “Clinical ultrasound” has contents: Ocular ultrasound, soft tissue procedures, musculoskeletal, lower extremity deep vein thrombosis, x, abdominal procedures, pericardiocentesis, thoracentesis, US-guided peripheral nerve blocks, lumbar puncture. | 9 Ocular Ultrasound Dasia Esener INDICATIONS • Assess vision loss or impairment • Evaluate eye trauma IMAGE ACQUISITION AND INTERPRETATION Equipment • High frequency linear probe • High frequency endocavity probe Preparation • Sterile adhesive for eye protection • Ultrasound gel Steps 1. Identify normal structures. 2. Identify abnormal structures and foreign bodies. Sonographic Landmarks 1. Cornea 2. Anterior chamber 3. Pupil 4. Ciliary body 5. Posterior chamber 6. Lens artifact 7. Vitreous 8. Retina 9. Optic nerve 59 60 Clinical Ultrasound: A How-To Guide Step 1: Identify normal structures • Place probe in transverse orientation over the center of the eye with probe indicator pointing • Rest the wrist or little finger on the patient’s face to avoid unnecessary pressure on eye. • Identify the lens, vitreous, and retina. • Note that the retina is hyperechoic and tethered at the optic nerve; the vitreous is anechoic. • Have patient move eye left, right, up, and down. • Change probe positioning to the sagittal orientation and repeat the exam. • Evaluate both the affected and non-affected eye. Step 2: Identify abnormal structures and foreign bodies • Have the patient look in all four directions while observing movement within the globe such as vitreous hemorrhage, foreign bodies, or detached retina. • Foreign body (*). 1 The macula is temporal to the optic nerve; placing the probe indicator temporally ensures that the macula is always on the side of the indicator on the screen. This is important when evaluating retinal pathology. Ocular Ultrasound • Ocular lymphoma (*). • Retinal detachment (*). • Note when the retina detaches, a thin, hyperechoic membrane floats freely in the vitreous (*). 61 62 Clinical Ultrasound: A How-To Guide • Evaluate whether the detached retina extends beyond the macula. • Note that retinal detachments that extend past the retina are considered “macula off” and will have central .
