The Growing Role of Ocular Ultrasound Across Clinical Settings
Point-of-care ultrasound (POCUS) is a portable diagnostic tool used by trained healthcare professionals to enhance patient assessment across a wide range of clinical settings. Originally adopted in critical care, its use has expanded over the past decade into prehospital, primary care, and ambulatory environments. This expansion has enabled clinicians to apply ultrasound in increasingly focused ways - including targeted assessments of the eye through ocular ultrasound. 1
What Is Ocular Ultrasound?
Ocular ultrasound is a noninvasive imaging technique that uses high-frequency sound waves to visualize the structures of the eye. Because ultrasound does not rely on light to generate an image, it is especially valuable when the view to the back of the eye is blocked by conditions such as cataracts, hemorrhage, or trauma. It is commonly used in clinical care, including ophthalmology and ocular oncology. 2
Common Uses of Ocular Ultrasound
Ocular ultrasound serves several important clinical purposes across a wide range of eye conditions.
It is particularly valuable in the evaluation of retinal detachment, which appears on ultrasound as a mobile, hyperechoic membrane that remains tethered to the optic nerve and ora serrata and often shows a characteristic serpentine motion with eye movement. 3 Color Doppler can reveal blood flow within the detached retina,4 and ultrasound is also routinely used to monitor treated retinal tumors or detect local recurrence. 2
Ultrasound is also central in evaluating ocular masses, helping clinicians detect and characterize lesions such as choroidal nevi and melanoma, 2 measure lesion dimensions with B-scan, 2 identify high-risk features like echolucency or proximity to the optic nerve, 4 and visualize tumor vascularity using Doppler 4 or microbubble contrast. 2 In cases of ocular trauma, ultrasound can help identify lens dislocation, foreign bodies (when globe rupture is not suspected), retrobulbar hematoma, and trauma-related retinal detachments. 3
Other common uses include posterior vitreous detachment (PVD), vitreous hemorrhage, choroidal detachment, and helping to evaluate signs associated with increased intracranial pressure. 3 4
Different ultrasound modes can also offer different types of information, including:
A-Scan Ultrasound
- A one-dimensional measurement of echo amplitude.
- Typically uses 7–11 MHz transducers.
- Commonly used to:
- Measure axial length of the eye (critical for cataract surgery planning).
- Assess echogenicity of ocular tumors and other internal structures. 2
B-Scan Ultrasound
- Produces a two-dimensional cross-sectional image of the eye.
- Uses 10–20 MHz probes.
- Commonly used to:
- View the posterior segment including retina, choroid, sclera, and vitreous. 2
Ultrasound Biomicroscopy (UBM)
- A high-frequency (40–100 MHz) technique used to image anterior segment structures in fine detail.
- Commonly used to:
- Evaluate the iris, ciliary body, anterior chamber angle, and anterior tumors. 2
Doppler Ultrasound
- Adds information about vascular flow within lesions or ocular structures.
- Helps differentiate tumors based on blood flow patterns.
How Ocular Ultrasound Is Performed
Ocular ultrasound generally follows a straightforward technique designed to obtain high-quality images while minimizing pressure on the eye. The examination begins with the patient closing the eye while seated or lying comfortably. A clear plastic film is often placed over the eyelid, and ultrasound gel is applied on top to prevent direct pressure on the globe. A high-frequency linear probe is then used to scan the eye in both transverse and sagittal planes. During the scan, the patient is asked to look up and down as well as side to side, allowing dynamic visualization. 2 3 4
Advantages and Limitations
Ocular ultrasound offers several meaningful advantages that make it a valuable imaging tool across clinical settings. It provides real-time imaging and is effective even when the internal structures of the eye cannot be directly visualized, such as in cases of dense cataract or vitreous hemorrhage. 2 Because it uses sound waves rather than ionizing radiation, it is considered to pose minimal risk to patients, and its relatively low cost and high portability make it accessible in a wide range of environments. 3 Ultrasound also allows dynamic assessment of membranes and fluid, enabling clinicians to observe how structures move within the eye. 4
However, there are important limitations to consider. UBM has lower resolution than anterior segment optical coherence tomography (AS-OCT), and the technique is highly operator-dependent, requiring experience to accurately localize and evaluate lesions. Ultrasound biomicroscopy (UBM) also has limited penetration—only about 3 to 6 mm—which restricts visualization to the anterior segment.
Additionally, ocular ultrasound should not be performed when a globe rupture is suspected, as any pressure on the eye can worsen the injury. 2 3
Summary:
Ocular ultrasound is a highly valuable imaging tool for visualizing both anterior and posterior eye structures, especially when direct visualization is limited. With multiple modalities—A-scan, B-scan, ultrasound biomicroscopy, and Doppler—it can detect detachments, hemorrhage, masses, lens abnormalities, and signs of increased intracranial pressure. While it requires training for accurate interpretation, its accessibility, safety, and diagnostic versatility make it an essential technique in ophthalmic and emergency care.
References:
#1: Fraleigh CDM, Duff E. Point-of-care ultrasound: An emerging clinical tool to enhance physical assessment. The Nurse practitioner. 2022;47(8):14-20. doi:10.1097/01.NPR.0000841944.00536.b2
#2: Kadakia A, Zhang J, Yao X, Zhou Q, Heiferman MJ. Ultrasound in ocular oncology: Technical advances, clinical applications, and limitations. Experimental biology and medicine (Maywood, N.J.). 2023;248(5):371-379. doi:10.1177/15353702231169539
#3: Bates A, Goett HJ. Ocular Ultrasound. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. PMID: 29083793.
#4: Southern S. Ultrasound of the eye. Australasian Journal of Ultrasound in Medicine. 2009;12(1):32-37. doi:10.1002/j.2205-0140.2009.tb00005.x
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