Bedside Ocular Ultrasound for the Detection of Retinal Detachment in the Emergency Department

Abstract

Objectives: Acute retinal detachments (RD) can be difficult to diagnose and may require emergent intervention. This study was designed to assess the performance of emergency department ocular ultrasound (EOUS) for the diagnosis of RD.Methods: This was a prospective, observational study using a convenience sample of emergency department (ED) patients. Physicians performed EOUS for the diagnosis of RD prior to evaluation by an ophthalmologist. The criterion standard was the diagnosis of a RD by the ophthalmologist who was blinded to the results of EOUS.Results: Fifteen physicians evaluated 48 patients with acute visual changes. Eighteen patients (38%) had RDs and all were correctly identified (true positives). Of the 30 patients (62%) without RD, 25 patients were correctly identified (true negatives), and five patients with vitreous hemorrhages were misidentified as having RDs (false positives). Therefore, the sensitivity and specificity of EOUS for RD were 100% (95% confidence interval [CI] = 78% to 100%) and 83% (95% CI = 65% to 94%), respectively.Conclusions: Emergency department ocular ultrasound is sensitive for the diagnosis of RD and may have a role in excluding RD in patients presenting to the ED.ACADEMIC EMERGENCY MEDICINE 2010; 17:913-917 ª

Retinal Detachment Due to Facial Gunshot Wound: The Utility of Ultrasonography in a Medically Austere Environment

“…Diagnosis of retinal detachments has been demonstrated using such a technique in the setting of one large ED with full specialty backup (12). A recent prospective, observational study demonstrated retinal detachment diagnosis with 100% sensitivity by emergency physicians (13). Although these studies were performed at single institutions on relatively small populations, the results suggest that ultrasonography can be used to diagnose retinal detachments with great utility.…”

Sports medicine ultrasound (US) beyond the musculoskeletal system: use in the abdomen, solid organs, lung, heart and eye

“…Retinal detachments are funnel-shaped, thick projections, which may wave during ocular movement and attach at the optic disk (figure 12). 41 Vitreous detachments may appear like fine funnel shapes that wave freely and do not attach. The two may be indistinguishable; however, presence of echogenic material suggests injury and requires immediate further evaluation 40–44…”

3D Ocular Ultrasound Using Gaze Tracking on the Contralateral Eye: A Feasibility Study

“…For example, in vitreo-retinal surgery, preoperative planning with ultrasound can be used [5]. Recent studies have also shown the benefit of ocular ultrasound in emergency medicine, such as diagnosing retinal detachment [6,7]. There are some pathological characteristics that differentiate retinal detachment from other abnormalities such as vitreous hemorrhages [7].…”

“…Recent studies have also shown the benefit of ocular ultrasound in emergency medicine, such as diagnosing retinal detachment [6,7]. There are some pathological characteristics that differentiate retinal detachment from other abnormalities such as vitreous hemorrhages [7]. Clinical manifestation of retina and vitreous detachments varies depending on where the adhesion is strongest [8].…”

“…Since ultrasound has poor penetration of the cornea and lens, images are taken through the sclera when the gaze is deviated toward different positions [1]. However, the evaluation of pathological features using such 2D ultrasound makes the examination more complex and may contribute to false diagnoses [7]. In order to obtain views of the entire posterior segment, multiple ultrasound images must be captured for a variety of gaze directions.…”