Ultrasonographic assessment of paediatric ocular emergencies: A tertiary eye hospital based observation

Abstract

Background: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the first point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies.

Methods: A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids.

Results: Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80 (65.57%) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage (8.19%), retinal detachment (6.55%), choroidal detachment (4.91%), posteriorly dislocated clear lens (0.81%) and retained intraocular foreign body (5.73%). Non-traumatic cases constituted around 42 (34.42%) eyes, which included corneal ulcer (7.37%), retinoblastoma (6.55%), endophthalmitis (4.91%), extra-ocular muscle cysticercosis (4.91%), orbital cellulitis (4.09%), periocular haemorrhage (2.45%), proptosis(1.63%), paediatric cataract (1.63%) and cryptophthalmos (0.81%). No adverse events of performing the ultrasound was noted.

Conclusion: First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of significant posterior segment and orbital diseases.

Keywords: Paediatric ocular emergencies; Posterior segment and orbital pathologies; Ultrasound B scan.

Figure 1

Various posterior segment pathologies showed by ultrasonography. A: High amplitude membranous echo with little after movements attached to the optic disc and persisting till low gain suggestive of retinal detachment; B: Similar findings as retinal detachment along with thick double peak dome-shaped elevation not extending beyond the equator is suggestive of choroidal detachment; C: Inferior high amplitude localized spike with shadowing is suggestive of retained intraocular metallic foreign body; D: Mild to moderate amplitude dot like echoes filling the entire vitreous cavity following trauma is suggestive of vitreous haemorrhage.

Figure 2

Ultrasonographic evaluation for nontraumatic concerns. A: Diffuse intravitreal mass with internal localized high amplitude spikes are suggestive of specs of calcification in case of retinoblastoma; B: Posteriorly dislocated relatively biconvex structure with internal hollowness is suggestive of posteriorly dislocated lens; C: Well defined cystic lesion within an extraocular muscle having a localized high amplitude spike is characteristic of cysticercosis; D: In a case of a severely traumatized eye showing irregularity and discontinuity along the posterior ocular coats.