Ocular Ultrasound
What is Ocular Ultrasound?
Ocular ultrasound, also referred to as ocular echography or B-scan is a non-invasive and painless test utilised in clinical settings to evaluate the structure of the eye and identify potential abnormalities. Similar to other ultrasound procedures, ocular ultrasound relies on the reflection of sound waves to generate detailed images of the eye’s internal structures, aiding in diagnosis and treatment planning.
Ocular ultrasound is recommended in specific situations where conventional eye examination is limited due to media opacities, these include:
- Suspected retinal detachment
- Vitreous hemorrhage
- Ocular mass or tumours
- Inflammatory disease
- Dense cataracts or corneal opacities
OCT can also image the front portion of the eye, including the cornea, iris, and lens. This is helpful in assessing conditions such as corneal abnormalities and angle-closure glaucoma.
Ocular ultrasound is a diagnostic tool that can assist in the diagnosis of various eye conditions. Some of the conditions that ocular ultrasound can help diagnose include:
Tumours: Ocular ultrasound can provide valuable information about the presence, size, and location of intraocular tumours, such as choroidal melanoma or retinoblastoma. It aids in the evaluation and management of these tumours.
Retinal Detachment: Ocular ultrasound is particularly useful in diagnosing retinal detachment. It can visualise the separation of the retina from the underlying layers of the eye and help determine the extent and location of the detachment.
Vitreous Hemorrhage: Ocular ultrasound can detect and assess vitreous haemorrhage, which is bleeding within the gel-like substance (vitreous humour) that fills the eye. It helps identify the source of bleeding and guides appropriate management.
Intraocular Foreign Bodies: When there is suspicion of an intraocular foreign body, ocular ultrasound can help locate and characterise the foreign object. This information assists in planning surgical interventions if required.
Ocular Trauma: Ocular ultrasound is valuable in evaluating and determining the extent of injury following ocular trauma, including assessing the presence of haemorrhage, fractures, or other structural abnormalities.
Ocular ultrasound plays a crucial role in the diagnosis and management of these and other eye conditions, providing valuable information to guide treatment decisions and improve patient outcomes.
Ocular ultrasound is recommended in specific situations where conventional ophthalmoscopy is limited or hindered by certain eye conditions. The reasons for recommending ocular ultrasound include:
Retinal Detachment or Retinal Tears: Ocular ultrasound helps assess and confirm the presence of retinal detachment or tears when direct visualisation is challenging due to factors like corneal opacities or dense cataracts.
Large Corneal Opacities: In cases where the cornea is extensively opaque, ocular ultrasound provides a means to evaluate the underlying structures of the eye, including the retina and vitreous.
Vitreous Hemorrhage: Ocular ultrasound assists in assessing vitreous haemorrhage, a condition where bleeding in the vitreous humour obscures the view of the retina. It helps determine the extent and underlying cause of the haemorrhage.
Posterior Segment Media Haze: When conditions such as media haze or opacities prevent a clear clinical evaluation of the posterior segment, ocular ultrasound aids in visualizing and analysing the retina, choroid, and sclera.
Ocular Masses and Lesions: Ocular ultrasound is valuable in understanding the nature and characteristics of ocular masses or lesions, including those involving the optic disc. It helps differentiate retinal detachment from other conditions and can assist in localising intraocular foreign bodies or evaluating orbital lesions.
Inflammatory Diseases: Ocular ultrasound plays a role in evaluating the retina, choroid, and sclera in various inflammatory diseases, assisting in diagnosis and treatment planning.
By utilising ocular ultrasound, clinicians can overcome limitations posed by certain eye conditions and gain valuable insights into the underlying pathology, leading to accurate diagnoses and appropriate management strategies.
OCTA is a specialised form of OCT that provides information about the blood flow within the retina and choroid without the need for dye injection. It aids in assessing blood supply to the macula in patients with diabetic retinopathy and retinal vein occlusions as well as non-invasive visualisation of macular neovascularisation.
Ocular ultrasound provides valuable information about various aspects of the eye’s anatomy and pathology. It can show:
Change in Globe Size: Ocular ultrasound helps assess any alterations in the size of the eye, such as enlargement or shrinkage, which can indicate certain conditions or pathologies.
Optic Nerve Evaluation: The optic nerve, crucial for vision, can be visualised and evaluated using ocular ultrasound. It allows for the assessment of its structure, integrity, and any abnormalities.
Scleral Buckling: Ocular ultrasound can detect and evaluate the presence of scleral buckling, a surgical technique used to repair retinal detachments by indenting the sclera. This information aids in assessing the success of the procedure.
Foreign Body Detection: Ocular ultrasound helps identify the presence and location of foreign bodies within the eye, providing crucial information for proper management and removal.
Tumour Size: Ocular ultrasound allows for the measurement and assessment of the size of ocular tumours. This information is essential for diagnosing and monitoring the progression of the tumour.
Globe Perforation: In cases of trauma or other conditions that may result in globe perforation, ocular ultrasound can reveal the extent and location of the perforation.
Retrobulbar Hematoma or Emphysema: Ocular ultrasound assists in diagnosing retrobulbar hematoma (bleeding behind the eye) or emphysema (presence of air behind the eye), which may occur as a result of trauma or other underlying conditions.
Lens Subluxation/Dislocation: Ocular ultrasound can detect abnormalities or displacement of the lens, such as subluxation or dislocation, aiding in the diagnosis and management of these conditions.
By providing detailed imaging and visualisation, ocular ultrasound helps clinicians gain critical insights into the eye’s structures, enabling accurate diagnoses and appropriate treatment decisions.
Ocular ultrasound offers several benefits in the field of ophthalmology. Some of these benefits include:
Improved Visualisation: Ocular ultrasound allows for the visualisation of structures within the eye that may be obscured by opaque substances such as dense cataracts or corneal opacities. It provides a clear view of these structures, aiding in accurate diagnosis and treatment planning.
Real-time Information: Ocular ultrasound provides real-time information about certain conditions, such as retinal detachment. It allows clinicians to assess the status and extent of detachment immediately, facilitating prompt decision-making and appropriate intervention.
Safety: Ocular ultrasound is a safe imaging technique that does not expose patients to ionizing radiation, unlike other imaging modalities like X-rays or CT scans. It can be used in various patient populations, including pregnant women and children, without posing any significant risks.
Radiation-Free: As mentioned earlier, ocular ultrasound does not involve the use of radiation. This aspect makes it a preferred imaging method, particularly when repeated evaluations or monitoring are required.
Accessibility and Affordability: Ocular ultrasound is widely accessible, and the equipment required for performing ultrasound examinations is readily available in many healthcare settings. Moreover, compared to other imaging techniques, ocular ultrasound is relatively low-cost, making it a cost-effective option for diagnosing and managing ocular conditions.
Overall, ocular ultrasound provides valuable information, is safe to use, and offers advantages such as improved visualisation and real-time assessment, making it a valuable tool in the field of ophthalmology.
Fluorescein Angiography and Indocyanine Green (ICG) Angiography
Fluorescein Angiography and Indocyanine Angiography are diagnostic tests used to examine the blood flow in the retina. It involves injecting a special dye called Fluorescein or ICG into a vein in your arm, then taking a series of photographs as the dye circulates through the blood vessels in the retina. The test identifies areas of leaking or abnormal blood vessels, blockages, swelling, or other changes that may affect the health and function of the retina.
Fluorescein Angiography and Indocyanine Angiography are often used to diagnose and treat conditions such as:
- Macular Degeneration
- Diabetic Retinopathy
- Macular Edema
- Retinal Vascular Disease
Wide view Retinal Photography and Autofluorescence
Wide-view retinal photography uses a specialized camera that takes images of your retina to detect and monitor macular and retinal conditions. In addition to macular pathologies, ultra-widefield retinal photography is particularly useful in the assessment of peripheral retinal pathologies and retinal tears. Autofluorescence is a special non-invasive imaging technique helpful in the detection of generalized retinal disorders such as retinal degeneration and dystrophies caused by genetic mutations.
During an ocular ultrasound, your eye will be numbed using anaesthetic drops to minimise discomfort. The procedure is quick and painless, with no serious risks or side effects. A probe will be placed over your eye, and you may be asked to move your eye back and forth. Your pupils won’t be dilated, but your vision may be temporarily blurred. The entire test typically takes around 15 minutes, and the results are available immediately.
After an ocular ultrasound, it is generally safe to drive within 30 minutes of the procedure. However, if you feel more comfortable, it is advisable to arrange for someone else to drive you.
It is important not to rub your eyes until the anaesthetic has completely worn off. This precaution is to prevent any accidental scratching of the cornea while the numbing effect is still present.
There are two main types of ocular ultrasound: A-scan and B-scan.
A-Scan: This type of ultrasound measures the length of the eye, which is useful in determining the appropriate lens implant for cataract surgery. During an A-scan, you sit upright in a chair and rest your chin while looking straight ahead. An oiled probe is gently placed against the front of your eye as it is scanned. Alternatively, if lying down, a fluid-filled cup or water bath is placed against the surface of your eye while it is scanned.
B-Scan: The B-scan is used to visualise the space behind the eye, especially when conditions like cataracts obstruct the view. During a B-scan, you sit with your eyes closed, and a gel is applied to your eyelids. You will be asked to move your eyeballs in different directions while an ultrasound probe is placed against your closed eyelids.
Ocular ultrasound offers several benefits in the field of ophthalmology. Some of these benefits include:
Improved Visualisation: Ocular ultrasound allows for the visualisation of structures within the eye that may be obscured by opaque substances such as dense cataracts or corneal opacities. It provides a clear view of these structures, aiding in accurate diagnosis and treatment planning.
Real-time Information: Ocular ultrasound provides real-time information about certain conditions, such as retinal detachment. It allows clinicians to assess the status and extent of detachment immediately, facilitating prompt decision-making and appropriate intervention.
Safety: Ocular ultrasound is a safe imaging technique that does not expose patients to ionizing radiation, unlike other imaging modalities like X-rays or CT scans. It can be used in various patient populations, including pregnant women and children, without posing any significant risks.
Radiation-Free: As mentioned earlier, ocular ultrasound does not involve the use of radiation. This aspect makes it a preferred imaging method, particularly when repeated evaluations or monitoring are required.
Accessibility and Affordability: Ocular ultrasound is widely accessible, and the equipment required for performing ultrasound examinations is readily available in many healthcare settings. Moreover, compared to other imaging techniques, ocular ultrasound is relatively low-cost, making it a cost-effective option for diagnosing and managing ocular conditions.
Overall, ocular ultrasound provides valuable information, is safe to use, and offers advantages such as improved visualisation and real-time assessment, making it a valuable tool in the field of ophthalmology.