Ocular ultrasound evaluates the posterior segment of the eye that a fundoscopic exam often cannot — through a closed lid, in a supine patient, without dilation. It identifies retinal detachment, vitreous hemorrhage, lens dislocation, and indirect evidence of elevated intracranial pressure.
The exam is performed with a closed eye, a generous gel layer, and no pressure on the globe.
Curated from the POCUS 101 Ocular Ultrasound Made Easy: Step-By-Step Guide. The video clips of retinal detachment and vitreous pathology in motion are essential viewing — these are dynamic diagnoses.
Ocular/orbital preset if the machine has one. Depth set so the globe fills most of the screen with the optic nerve visible posteriorly.
A transparent adhesive dressing over the closed lid keeps gel out of the eye. Apply a generous gel mound so the probe rests on gel, not lid.
Brace your hand on the patient's forehead or nasal bridge so probe pressure cannot transmit to the globe.
Transverse and sagittal · fan through the entire globe
Identify the anterior chamber, the lens, the anechoic vitreous, and the retina as the bright posterior boundary. Fan completely through the globe in both planes — peripheral pathology is missed by a single midline slice.
Slowly raise gain from low to high
Subtle vitreous pathology — hemorrhage, posterior vitreous detachment — is often invisible at low gain and only appears as gain is increased. Examine the vitreous at both low and high gain before calling it clear.
Patient looks left-right and up-down with eyes closed
Eye movement differentiates the membranes. A detached retina moves stiffly with a tethered undulation; a posterior vitreous detachment is a thinner, more freely mobile membrane; vitreous hemorrhage swirls with eye movement and settles when still.
Optic nerve in long axis behind the globe · measure 3 mm posterior to the retina
Identify the hypoechoic optic nerve extending posteriorly from the globe. Measure the sheath diameter 3 mm behind the posterior globe wall, perpendicular to the nerve. Average measurements from both eyes.
| Finding | Appearance | Action |
|---|---|---|
| Retinal detachment | Thick, echogenic membrane tethered to the optic disc; stiff undulation with eye movement; may form a funnel shape | Emergent ophthalmology consultation |
| Posterior vitreous detachment | Thin, low-echogenicity membrane, freely mobile, may cross the disc; often needs higher gain to see | Urgent ophthalmology follow-up; can coexist with retinal tears |
| Vitreous hemorrhage | Mobile echogenic material swirling within the vitreous on eye movement | Ophthalmology referral; search carefully for underlying detachment |
| Lens dislocation | Lens displaced from its position behind the iris, seen within the vitreous | Ophthalmology consultation; assess for associated trauma |
| ONSD | > ~5 mm | Supports elevated ICP in context; correlate with CT and clinical picture |
| Globe rupture signs | Loss of globe contour, decreased globe volume, intraocular hemorrhage | Stop scanning; shield the eye; emergent ophthalmology |
Attachment at the optic disc is what separates retinal detachment from posterior vitreous detachment. Always image the disc and trace the membrane's insertion before naming it.
Vitreous hemorrhage and PVD are low-amplitude echoes. At default gain the vitreous can look clear. Sweep the gain up before declaring a normal exam.
The membranes are distinguished by how they move. If the patient has not moved their eyes during the scan, the differential between detachment types has not been assessed.
In periorbital swelling, image the pupil in transverse while shining a light in the contralateral eye — the consensual response is visible on ultrasound when the lids cannot open.
If the mechanism or exam suggests rupture, the risk of extruding intraocular contents outweighs the diagnostic value. Shield the eye and involve ophthalmology first.
Sheath diameter varies between patients and measurement technique matters. Use it to raise or lower suspicion of intracranial hypertension alongside imaging — not to replace it.
A starting template for the POCUS note. Text in brackets [ ] and pick-lists in { } are fields to complete. Save it as a SmartPhrase, then edit every field to match the actual study.
POINT-OF-CARE ULTRASOUND: OCULAR
Indication: {vision loss : floaters / flashes : trauma : ? elevated ICP}
[side ***]
Exam type: Focused / limited, closed lid, no globe pressure
Operator: @ME@ Interpretation: independent, real-time
Probe: linear (ocular preset)
Globe rupture suspected: {no : yes - exam deferred / limited}
FINDINGS ([right : left])
- Retina: {attached : detachment tethered at disc}
- Vitreous: {clear : posterior vitreous detachment : hemorrhage}
- Lens: {in position : dislocated}
- Optic nerve sheath diameter (3 mm behind globe): *** mm
- Pupillary response (if assessed): {normal : ***}
IMAGE QUALITY: adequate / limited by [***]
Images saved and archived to [PACS / Qpath / ***].
IMPRESSION: [***]. Ophthalmology {consulted : not indicated}.
I personally performed and interpreted this study.
Electronically signed: @ME@ @TD@ @NOW@
Sample template only — not a validated institutional SmartPhrase. Verify wording, image-archival, and attestation requirements against your department's POCUS credentialing, coding, and compliance policies before clinical use. Documentation supports, but does not replace, the medical record and QA workflow.