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Abstract
The use of ocular ultrasonography for the evaluation of emergency patients has recently
been described in the emergency medicine (EM) literature. There are a number of potential
uses that may greatly aid the emergency physician (EP) and avoid lengthy consultation
or other diagnostic tests.
To examine the accuracy of bedside ultrasonography as performed by EPs for the evaluation
of ocular pathology.
This prospective, observational study took place in a high-volume, suburban community
hospital with an EM residency program. All patients arriving with a history of eye
trauma or acute change in vision were eligible to participate in the study. A 10-MHz
linear-array transducer was used for imaging. All imaging was performed through a
closed eyelid, using water-soluble ultrasound gel. Investigators filled out standardized
data sheets and all examinations were taped for review. All ultrasound examinations
were followed by orbital computed tomography or complete ophthalmologic evaluation
from the ophthalmology service. Statistical analysis included sensitivity, specificity,
and positive and negative predictive values.
Sixty-one patients were enrolled in the study; 26 were found to have intraocular pathology
on ultrasound. Of these, three had penetrating globe injuries, nine had retinal detachments,
one had central retinal artery occlusion, and two had lens dislocations. The remaining
pathology included vitreous hemorrhage and vitreous detachment. Emergency sonologists
were in agreement with the criterion standard examination in 60 out of 61 cases.
Emergency bedside ultrasound is highly accurate for ruling out and diagnosing ocular
pathology in patients presenting to the emergency department. Further, it accurately
differentiates between pathology that needs immediate ophthalmologic consultation
and that which can be followed up on an outpatient basis.