Focused Bedside Ocular Ultrasound

A 55-year-old man with history of alcohol abuse presented status-post assault. The patient appeared intoxicated with slurred speech, hematoma over the right forehead, and a swollen and ecchymotic right eye, but was otherwise hemodynamically stable. The patient was unable to open his eyes for examination. Head, facial, and orbital computed tomography (CT) scans were ordered. A bedside ocular ultrasound (Figure 1; Video Clip S1, available as supporting information in the online version of this paper) was quickly performed to evaluate for evidence of increased intracranial pressure (Video Clip S2, available as supporting information in the online version of this paper), retinal detachment (Video Clip S3, available as supporting information in the online version of this paper), vitreous hemorrhage (Video Clip S4, available as supporting information in the online version of this paper), foreign body, lens dislocation, and retrobulbar hematoma (Video Clip S5, available as supporting information in the online version of this paper). The focused ocular ultrasound showed no evidence of increased intracranial pressure with a normal measurement of the optic sheath (<5 mm) and found vitreous hemorrhage. Later, CT scans confirmed ultrasound findings in addition to right orbital floor fracture without evidence of entrapment, and the patient was admitted to the trauma service with ophthalmology consult.

Figure 1.  Apply generous amount of gel over the closed eyelid. Place a high-frequency linear probe over gel, scan in two planes without exerting pressure on the eye. With the eye closed, instruct the patient to move his eye in four directions.