Tricks of the Trade: Diagnosing retinal detachment with ultrasound

In a sneak peak 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.

Image courtesy of Dr. Patrick Lenaghan.

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