Eye and Orbit Ultrasounds

Definition

Ultrasound imaging equipment allows eye specialists (ophthalmologists) to "see" the eye in great detail without the pain and risk of exploratory surgery, or the limitations and uncertainty inherent to traditional visual examination. Ultrasound is used to detect and diagnose many eye diseases and injuries, to measure the eye prior to corrective surgery, and directly as a treatment tool.

Purpose

An ophthalmologist uses ultrasonic imaging to help diagnose the underlying cause(s) of a patient's symptoms, to assess the general condition of an injured eye, and to measure the eye prior to corrective surgery. Situations that may call for ultrasonic imaging include:

• Excessive tearing or visible infection. These external symptoms could indicate a serious underlying problem such as a tumor, an internal infection, the presence of a deeply lodged irritant (foreign body), or the effects of a previously unrecognized injury. When presented with general symptoms, ultrasound can speed diagnosis if a serious condition is suspected.
• Impaired vision. Fuzzy vision, poor night vision, restricted (tunnel) vision, blind spots, extreme light sensitivity, and even blindness can all stem from inner eye conditions ranging from glaucoma and cataracts, to retinitis, detached retina, tumors, or impaired blood circulation. Again, high resolution ultrasound can quickly identify causes and pinpoint their location. A special type of ultrasound, known as Doppler, can even perceive and measure circulation in the tiny blood vessels of the eye.
• Eye trauma. The eye can be damaged by a direct impact or a puncture wound, as a result of a general head trauma, or by intense light exposure. Even when the cause of injury is obvious, ultrasound can reveal the exact type, extent, and location of damage, from deformations and ruptures to internal bleeding, and help to guide emergency care efforts.
• Lens replacement surgery. Exact measurement of the eye's optical dimensions with ultrasound greatly improves the visual outcome for cataract patients receiving permanent synthetic lenses; and for severely myopic patients receiving implanted corrective lenses.

Ophthalmic ultrasound imaging is also used routinely to guide the precise placement of instruments during surgery, and can be used directly for the treatment of glaucoma and tumors of the eye.

Precautions

Ultrasound of the eye, properly performed by qualified personnel using appropriate equipment, has no risks. There is no evidence to suggest that the procedure itself poses any threat to a healthy eye, or worsens the condition of a diseased or injured eye.

Description

Ophthalmic ultrasound equipment sends high frequency pulses of sound into the eye, where they bounce off the boundaries between different structures in the eye and produce a distinctive pattern of echoes. This echo pattern is received and interpreted by a computer to produce an image on a television screen. The time it takes an echo to return to the receiver corresponds to the depth it traveled into the eye.

Single transducer (the sound transmitter/receiver) ultrasound is used to measure distances within the eye. This is A-mode ultrasound. A linear array of transducers in a single small probe, B-mode, provides a picture of a cross section through the eye. Doppler mode ultrasound combines B-mode with the ability to detect and measure the flow of blood in the tiny vessels of the eye.

As a direct treatment tool, the vibrations of high intensity A-mode ultrasound can be used to heat and erode tumors. The same technique can be used to control glaucoma by selectively destroying the cells which produce the fluid that causes the internal pressure of the eye to rise.

The procedure followed in a regular ultrasonic eye examination is relatively simple. The patient relaxes in a comfortable chair in a darkened room. Mild anesthetic eye drops are administered and the head is held secure. The ultrasonic probe, coated with a sterile gel to ensure good contact, is lightly pressed against the eye as the images are made. The probe may be applied to the eyelid or directly to the eye, as necessary. The patient feels nothing else, and the whole office procedure takes about 15 minutes.

Preparation

Preparation by the patient is generally unnecessary, although under special circumstances an ophthalmologist may perform pretest procedures. The ophthalmologist and/or ultrasound technician will conduct all preparations at the time of the test.

Aftercare

Patients may experience partial and temporary blurred vision, as well as "eye strain" headaches. These symptoms usually fade within an hour of the procedure, during which time patients should rest their eyes and avoid all activities that require good eyesight, like driving.

Risks

Improperly focused, high-intensity ultrasound could burn and physically disrupt delicate eye tissue and cause injury. This risk is, however, slight and would arise only from improper use, or as a potential side effect of tumor or glaucoma treatment.

Normal results

A normal ultrasound scan would indicate a fully healthy eye. For therapeutic ultrasound, a normal result would be an improvement in the targeted condition, such as shrinking of a tumor or lessening of pressure inside the eye of a glaucoma patient.

Abnormal results

Because diagnostic ultrasound is generally used to investigate symptoms, the results of a scan will often be abnormal and they will detect evidence of an underlying condition.

Resources

ORGANIZATIONS

American Academy of Ophthalmology. 655 Beach Street, PO Box 7424, San Francisco, CA 94120-7424. 〈http://www.eyenet.org〉.

American Institute of Ultrasound in Medicine. 14750 Sweitzer Lane, Suite 100, Laurel, MD 20707-5906. (800) 638-5352. 〈http://www.aium.org〉.

National Eye Institute. 2020 Vision Place, Bethesda, MD 20892-3655. (301) 496-5248. 〈http://www.nei.nih.gov〉.

KEY TERMS

Cataracts— A clouding of the lens of the eye or the material immediately surrounding it, causing blurred vision. For many people it occurs naturally with aging, but may also result from injury.

Glaucoma— A common eye disease characterized by increased fluid pressure in the eye that damages the optic nerve, which carries sensations to the brain. Glaucoma can be caused by another eye disorder, such as a tumor or congenital malformation, or appear without obvious cause, but if untreated it generally leads to blindness.

Intraocular— Literally, within the eye.

Ophthalmologist— A medical doctor specializing in eye care who is generally, but not necessarily, an eye surgeon.

Retina— The third and innermost membrane of the eye, which contains the light-sensitive nerve tissue that leads into the optic nerve and is the primary instument of vision. Inflammation of the retina (retinitis) has many causes, including overexposure to intense light, diabetes, and syphilis.