Author: Claude (AI), from PubMed abstracts · Reviewed by: Dr Mina Abdelmseih · Reviewed: 2026-11-15 · Review due: 2027-11-15

Educational content only. Not personalised medical advice. Clinical decisions remain the responsibility of the treating clinician.

Ocular ultrasound and point-of-care ultrasound

Ocular ultrasound gives real-time images of the eye and orbit when the fundus cannot be seen or examination is limited [S3] [S12]. Point-of-care ultrasound (POCUS) by non-ophthalmologists is 94.2% sensitive and 96.3% specific for retinal detachment in a meta-analysis [S4], and handheld devices extend imaging to austere settings [S5]. It must be used with care in suspected open globe injury [S10].

Key points - Bedside ocular ultrasound is simple and quick and can help diagnose vitreous and retinal haemorrhage, retinal and vitreous detachment, infection, foreign bodies, retrobulbar haematoma and vascular pathology [S1]. - POCUS accuracy for retinal detachment did not differ significantly between emergency and non-emergency providers [S4]. - In suspected open globe injury, POCUS is highly sensitive and specific for some findings, but its use is controversial because of possible extrusion of globe contents [S10]. - Use the as-low-as-reasonably-achievable principle: the eye is one of the organs where exposure should be minimised [S7]. - Ultrasound biomicroscopy (UBM) is the only non-invasive high-resolution method for imaging the iridociliary complex and the anterior segment behind a corneal opacity [S8].

Evidence last checked: 2026-10-17 (PubMed abstracts).

Red flags: findings during the scan that need urgent action

• Suspected open globe (deep anterior chamber with retracted iris after trauma, haemorrhagic chemosis, hypotony, vitreous haemorrhage) [S2]. Stop, avoid any pressure on the eye, protect it and refer for surgical repair [S2] [S10].
• Retinal detachment on B-scan. Can cause significant vision loss if not rapidly diagnosed and referred [S4].
• Intraocular foreign body or retrobulbar haematoma [S1]: same-day ophthalmology.
• Enlarged optic nerve sheath diameter. A surrogate for raised intracranial pressure [S1] [S9]; urgent medical assessment [S1].
• Intraocular mass. Ultrasound measures posterior tumours and Doppler detects tumour vascularisation [S12]; refer to ocular oncology.

Recognise it: when to scan

• Opaque media or limited examination in the emergency setting [S1] [S3].
• Acute conditions readily diagnosed by ultrasound: retinal detachment, lens dislocation and globe rupture [S3].
• Occult globe rupture, when thorough slit-lamp examination is not possible (with CT) [S2].
• Children with corneal opacity or suspected anomalies behind the iris (UBM) [S8].
• Suspected raised intracranial pressure (optic nerve sheath diameter) [S1] [S9] [S11].
• Suspected giant cell arteritis: vascular ultrasound of the temporal arteries is a safe and reliable alternative to biopsy in rheumatology fast-track clinics, given an experienced sonographer [S6].

Confirm it: modes and technique

• Emergency physicians can image anterior and posterior chamber structures with a linear probe [S3].
• A mnemonic-based systematic scan of the eye and surrounding structures has been proposed for emergency use [S1].
• Ultrasound penetrates further than OCT but has lower resolution, and needs an experienced operator for accurate probe positioning [S12].
• For optic nerve sheath measurement in children, combine standardised A-scan with B-scan for accurate, repeatable data [S11]; paediatric data are scarce [S11].

Manage it: doing and acting on the scan at each resource tier

Before acting on this section, check the national and local guidelines, product information and regulatory approvals that apply where you practise. See the medical disclaimer.

Tier A (primary care / no specialist)

1. Where a portable ultrasound device and a trained user are available, it is a reliable, repeatable and inexpensive tool in austere settings [S5].
2. Use it to look for retinal detachment and vitreous haemorrhage when the fundus cannot be seen [S1] [S4], then refer.
3. Avoid scanning an eye with suspected open globe, because of the risk of extruding globe contents; protect it and refer [S10].

Tier B (general eye clinic)

1. Use B-scan when opaque media or limited examination prevent a fundus view [S1] [S3].
2. Train staff: safety begins with training in obtaining and interpreting valid images [S7].
3. Keep output and exposure as low as possible [S7].

Tier C (specialist centre)

1. Use A-scan, B-scan, UBM and Doppler for tumour characterisation and measurement [S12].
2. Use UBM in children with corneal opacity and anterior segment anomalies [S8].
3. Consider temporal artery ultrasound in suspected giant cell arteritis to speed diagnosis and avoid unnecessary steroid courses [S6].

Refer when

Pitfalls

• Pressing on a possibly ruptured globe [S2] [S10].
• Assuming a normal CT excludes open globe injury [S10].
• Overestimating resolution: ultrasound cannot match OCT detail [S12].
• Relying on optic nerve sheath measurement in children, where data are scarce [S11].
• Long, high-output scanning of the eye [S7].

Evidence notes

• Only one source gives pooled accuracy data [S4]; most are narrative reviews, largely from emergency medicine.
• The meta-analysis found wide confidence intervals and called for work on training protocols [S4].
• Sources conflict on scanning in open globe injury: one reports high sensitivity, but also controversy over extrusion risk [S10].
• Not covered by these sources: accuracy for vitreous haemorrhage and intraocular foreign body, optic nerve sheath cut-off values, training hours needed, and device costs.

Related articles

• Rhegmatogenous Retinal Detachment
• Intraocular foreign body
• Uveal melanoma: diagnosis and primary treatment

References

See the numbered source list below. Each marker [S#] links to its PubMed and DOI record.