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Cureus 2021 Jan 30;13(1):e13008. Epub 2021 Jan 30.

Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.

Background Ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD) has been proposed as a non-invasive, bedside method to detect raised intracranial pressure (ICP) in various clinical settings. We aimed to correlate the ONSD obtained from ultrasonography with the gold standard, intraventricular ICP, and to find out the cut-off point which predicts ICP accurately at different levels. Methodology A prospective double-blind study was carried out by performing ocular ultrasounds in 30 adult patients with features of intracranial hypertension. Read More

J Emerg Med 2021 Feb 23;60(2):220-222. Epub 2020 Oct 23.

Madigan Army Medical Center, Emergency Medicine, Joint Base Lewis-McChord, Washington.

Background: Emergency physicians frequently evaluate patients with vision changes. The differential for this chief symptom is broad. We present a unique cause of a fixed scotoma that started while the patient was running sprints. Read More

J Emerg Trauma Shock 2020 Jul-Sep;13(3):190-195. Epub 2020 Sep 18.

Department of Emergency Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.

Aim: The aim was to evaluate the use of bedside sonographic measurement of the optic nerve sheath diameter (ONSD) in the assessment of elevated intracranial pressure in patients with head injury coming to the emergency department (ED).

Methods: A prospective study of ED patients presenting with a history of acute head injury, an ocular ultrasound was performed for ONSD measurement, followed by a computed tomography (CT) of the brain. Three measurements were taken for each eye, then, the mean binocular ONSD measurement for each patient was obtained to ensure accuracy. Read More

Ultraschall Med 2020 Dec 8;41(6):618-645. Epub 2020 Dec 8.

Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.

Point-of-care ocular ultrasound (POCOUS) in the ambulatory and critical care setting has become an invaluable diagnostic tool for patients presenting with traumatic or atraumatic vision and ocular complaints. Sonographic bedside evaluation is intuitive and easy to perform and can accurately diagnose a variety of pathologies. These include detachment or hemorrhage of the retina or vitreous, lens dislocation, retrobulbar hematoma or air, as well as ocular foreign bodies, infections, tumors, and increased optic nerve sheath diameter that can be assessed in the setting of suspected increased intracranial pressure. Read More

World Neurosurg 2020 07 25;139:588-591. Epub 2020 Apr 25.

Division of Neurosurgery, Department of Surgery, Uniformed University of the Health Sciences, Bethesda, Maryland, USA. Electronic address:

Background: Orbital compartment syndrome (OCS) is a rare post operative complication of Neurosurgery. It presents typically acutely with loss of vision, loss of pupillary reaction, and limitation of extraocular movement. The etiology of OCS is most typically associated with increased pressure from a mass lesion in the orbit compromising the blood supply of orbital structures. Read More

J Emerg Med 2019 12;57(6):883-884

Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Salerno, Italy.

J Emerg Med 2019 Nov 26;57(5):705-709. Epub 2019 Jul 26.

M&M Eye Institute, Prescott, Arizona.

Background: Visual loss, ocular pain, and red eye are common presentations to front-line physicians in the emergency department, urgent care centers, or the primary care office. In recent decades, point-of-care ultrasound (POCUS) has been used by clinicians at the bedside in the evaluation and management of a vast array of patients, including those with ocular complaints.

Case Report: A 33-year-old man presented to the emergency department with left eye pain for 4 weeks' duration. Read More

J Emerg Med 2019 Mar 8;56(3):288-293. Epub 2018 Dec 8.

Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida.

Background: Cerebral venous thrombosis (CVT) is a rare, difficult-to-diagnose form of venous thromboembolic disease and is considered a type of stroke. Its presentation is highly variable and may be easily confused for more common and less debilitating or life-threatening diagnoses such as migraine, seizure, or idiopathic intracranial hypertension.

Case Report: A 25-year-old woman presented with a complaint of bifrontal throbbing headache and blurry vision. Read More

Niger J Clin Pract 2018 Jun;21(6):778-782

Department of Emergency Medicine, Faculty of Medicine, Uludag University, Bursa, Turkey.

Introduction: Headache is one of the most important complaints in emergency room (ER) admissions, and the rate of the increase in intracranial pressure in these cases should not be overlooked. This study was performed to investigate the value of the measurement of optic nerve sheath diameter (ONSD) by ocular ultrasound in ER patients with the complaint of headache and increase in intracranial pressure regarding this.

Materials And Methods: : A total of 100 patients who applied to the ER with the complaint of headache were included in this prospective study. Read More

J Neurol Sci 2018 Jan 24;384:91-95. Epub 2017 Nov 24.

Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China. Electronic address:

Background And Purpose: Neuromyelitis optica spectrum disorder (NMOSD) has been recognized as a disease characterized by severe visual afferent impairment. Abnormal eye movements, as the other important neuro-ophthalmic manifestation of NMOSD, were commonly overlooked. The aim of our study was to describe the ocular motor manifestations of AQP4-IgG positive NMOSD patients, and explore the value of eye movement abnormalities in the evaluation of the disabled disease. Read More

Crit Care 2016 08 15;20(1):227. Epub 2016 Aug 15.

Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA.

Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography. Read More

Retin Cases Brief Rep 2017 Summer;11(3):195-197

*Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and †Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Purpose: To determine the prevalence of retinopathy among patients undergoing heart transplantation screening and to determine the impact of this finding on eligibility for transplantation.

Methods And Patients: A retrospective case series was collected to perform an institutional review of all inpatient consults for dilated eye examinations on potential heart transplant candidates over 5.5 years-from March 27, 2008 to October 10, 2014. Read More

J Emerg Med 2016 Apr 12;50(4):e183-5. Epub 2016 Feb 12.

SC Medicina e Chirurgia d'Accettazione e d'Urgenza-OBI, Ospedale San Paolo, Savona, Italy.

Background: Ocular emergencies account for 2-3% of all emergency department (ED) visits. Sonographic evaluation of the eye offers a very useful diagnostic tool in the ED. In the ED setting, ocular ultrasound could identify a retinal detachment, or a massive vitreous hemorrhage, and the training for emergency medicine practitioners is quite easy. Read More

Emerg Med Pract 2015 Nov 1;17(11):1-21; quiz 21-2. Epub 2015 Nov 1.

Assistant Program Director, Assistant Professor, Sinai-Grace Emergency Department, Wayne State University, Detroit, MI.

Ocular injuries are common in the emergency department, and they are the most frequent cause of noncongenital monocular blindness in children and adults. This review provides evidence-based recommendations for the diagnosis, treatment, and disposition of patients with all types of ocular trauma, including pain management, the use of antibiotics, cycloplegics, steroids, antifibrinolytics, and patching. Bedside ocular ultrasound has profoundly expanded diagnostic capability, particularly for the multiply injured patient, and routine management and disposition of patients with corneal abrasions has evolved significantly as well. Read More

Indian J Radiol Imaging 2015 Apr-Jun;25(2):173-6

Department of Emergency Medicine, BJ Medical College, Civil Hospital, Ahmedabad, Gujarat, India.

Unlabelled: CNS Tuberculosis can manifest as meningitis, arachnoiditis and a tuberculoma. The rupture of a tubercle into the subarachnoid space leads to Tuberculosis Meningitis (TBME); the resulting hypersensitivity reaction can lead to an elevation of the intracranial pressure and hydrocephalus. While bedside optic nerve sheath diameter (ONSD) ultrasonography (USG) can be a sensitive screening test for elevated intracranial pressure in adult head injury, little is known regarding ONSD measurements in Tuberculosis Meningitis. Read More

Pediatrics 2015 Jan;135(1):e238-54

Retinopathy of prematurity (ROP) remains a significant threat to vision for extremely premature infants despite the availability of therapeutic modalities capable, in most cases, of managing this disorder. It has been shown in many controlled trials that application of therapies at the appropriate time is essential to successful outcomes in premature infants affected by ROP. Bedside binocular indirect ophthalmoscopy has been the standard technique for diagnosis and monitoring of ROP in these patients. Read More

Indian J Crit Care Med 2014 Nov;18(11):728-34

Department of Critical Care Medicine and Department of Radiology, Yashoda Multi-Speciality Hospital, Somajiguda, Hyderabad, Telangana, India.

Background And Aims: The aim was to evaluate efficacy of optic nerve sheath diameter (ONSD) by ultrasound as a noninvasive method for detecting raised intracranial pressure (ICP) in intensive care unit, to compare with computed tomography/magnetic resonance imaging (MRI) findings of raised ICP and to prognosticate ONSD value with treatment.

Materials And Methods: We conducted a prospective, observational study on 101 adults by including 41 healthy individuals in group A as control and 60 patients in group B admitted with fever, headache, vomiting, and altered sensorium. We examined them in supine position using 10 MHz linear array probe on closed eyelid. Read More

Teach Learn Med 2014 ;26(3):292-5

a Division of Emergency Medicine , Schulich School of Medicine & Dentistry , London , Ontario , Canada.

Background: The integration of bedside ultrasound into medical school curricula is limited by the availability of skilled faculty instructors. Peer mentors have been utilized successfully to teach clinical and procedural skills and may serve as a valuable resource for potential ultrasound instructors. We describe a method to train senior medical students as peer instructors for a combined ultrasound/physical exam curriculum and assessed junior medical students' perceptions of peer instruction relative to faculty. Read More

Ann Emerg Med 2015 Feb 27;65(2):199-203.e1. Epub 2014 Mar 27.

Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.

The diagnostic accuracy of emergency department (ED) ocular ultrasonography may be sufficient for diagnosing retinal detachment. We systematically reviewed the literature to determine the diagnostic accuracy of ED ocular ultrasonography for the diagnosis of retinal detachment. This review conformed to the recommendations from the Meta-analysis of Observational Studies in Epidemiology statement. Read More

Crit Care Clin 2014 Apr 12;30(2):227-41, v. Epub 2013 Dec 12.

Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, School of Medicine-Phoenix, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA.

Many ocular emergencies are difficult to diagnose in the emergency setting with conventional physical examination tools. Additionally, persistent efforts to re-examine the eye may be deleterious to a patient's overall condition. Ultrasound is an important tool because it affords physicians a rapid, portable, accurate, and dynamic tool for evaluation of a variety of ocular and orbital diseases. Read More

J Neurol 2014 Jan 27;261(1):121-9. Epub 2013 Oct 27.

Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, Korea.

Cerebral infarction presenting with isolated vertigo remains a diagnostic challenge. To define the clinical characteristics of unilateral infarctions restricted to the vestibular nuclei, two patients with isolated unilateral vestibular nuclear infarction had bedside and laboratory evaluation of the ocular motor and vestibular function, including video-oculography, bithermal caloric irrigation, the head impulse test (HIT) using magnetic scleral coils, and cervical and ocular vestibular-evoked myogenic potentials (VEMPs). We also reviewed the literature on isolated vertigo from lesions restricted to the vestibular nuclei, and analyzed the clinical features of seven additional patients. Read More

Eur J Emerg Med 2014 Aug;21(4):246-53

Department of aEmergency Medicine bEmergency Medicine, Division of Emergency Ultrasound, Johns Hopkins University, Baltimore, Maryland, USA.

The use of point-of-care ultrasound in the emergency department has expanded considerably in recent years, allowing enhanced evaluation of the patient with an emergent eye or vision complaint. The technique is simple and quick to perform, and can yield clinical information that may not be readily obtainable through physical or slit-lamp exams. Ocular bedside sonography can aid in the diagnosis of retinal and vitreous hemorrhage, retinal and vitreous detachments, ocular infections, foreign bodies, retrobulbar hematoma, or ocular vascular pathology. Read More

Childs Nerv Syst 2013 Dec 1;29(12):2275-80. Epub 2013 Jun 1.

Department of Emergency Medicine, University of California, San Franisco, 505 Parnassus Avenue, Room M24, San Francisco, CA, 94143-0203, USA,

Objective: To determine the feasibility and test characteristics of optic nerve sheath diameter (ONSD) measured by ocular ultrasound as a screening tool for ventriculoperitoneal shunt (VPS) failure.

Methods: Prospective observational study using a convenience sample of children 6 months to 18 years of age, presenting to an academic pediatric emergency department for evaluation of possible VPS failure between September 2008 and March 2009. ONSD was measured by anterior transbulbar and lateral transbulbar techniques. Read More

J Emerg Med 2013 Jun 20;44(6):1136-9. Epub 2013 Mar 20.

Stanford/Kaiser Residency Program, Stanford University School of Medicine, Stanford, CA 94305, USA.

Background: Retinal detachment is a true medical emergency. It is a time-critical, vision-threatening disease often first evaluated in the Emergency Department (ED). Diagnosis can be extremely challenging and confused with other ocular pathology. Read More

J Trauma 2011 Sep;71(3):779-81

Department of Anesthesia and Intensive Care, Cannizzaro Hospital, Catania, Italy.

Background: Increases in intracranial pressure (ICP) after head trauma require a rapid recognition to allow for adequate treatments. The aim of this study was to determine whether dilation of the optic nerve sheath, as detected by ocular ultrasound at the bedside, could reliably identify increases in ICP assessed with an intraparenchymal probe in adult head trauma patients.

Methods: Eleven head trauma injured adult patients admitted to the intensive care unit with a Glasgow Coma Scale score ≤8, with cerebral contusion confirmed by computed tomography scan, and that required invasive ICP monitoring, were enrolled in the study. Read More

Acad Emerg Med 2010 Sep;17(9):913-7

David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Olive View Medical Center and UCLA Medical Center, Sylmar, CA, USA.

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. Read More

J Emerg Med 2011 Jan 21;40(1):53-7. Epub 2009 Jul 21.

Department of Emergency Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.

Background: Retinal detachment is an ocular emergency posing diagnostic difficulty for the emergency practitioner. Direct fundoscopy and visual field testing are difficult to perform and do not completely rule out retinal detachment. Ophthalmologists use ocular ultrasound to enhance their clinical acumen in detecting retinal detachments (RD), and bedside ultrasound capability is readily available to many emergency practitioners (EP). Read More

Injury 2008 May 5;39(5):519-24. Epub 2008 Mar 5.

Trauma Service, Department of Surgery, L.T.M. Medical College and L.T.M.G. Hospital, Sion, Mumbai, India.

Background: CT has evolved as the gold standard for evaluation of head injury, but early CT is not always possible. Bedside ultrasonography is available in most trauma units and optic nerve ultrasound (ONUS) examination should be feasible.

Objective: To evaluate the role of ONUS for people with head injury. Read More

J Ultrasound Med 2005 Oct;24(10):1341-6

Department of Emergency Medicine, Medical College of Georgia, 1120 15th St, AF-2056, Augusta, GA 30912-4007, USA.

Objective: Eye conditions are common in emergency departments. Intraocular foreign bodies (IOFBs) are a frequent concern. Orbital computed tomography (CT) is traditionally used for evaluation. Read More

Acad Emerg Med 2002 Aug;9(8):791-9

Department of Emergency Medicine, Medical College of Georgia, Augusta, GA 30912-4007, USA.

Unlabelled: 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.

Objective: To examine the accuracy of bedside ultrasonography as performed by EPs for the evaluation of ocular pathology. Read More