Ophthalmology Ultrasound Training Course

1. UBM and US
training course
Mohamed ELShafie
MD, HMS Alumni

6. TIP 1:
HOW DOES IT
WORK?
Physics &Principle

7. • The greater the difference in the acoustic
impedance of the two media stronger the
reflection of sound wave (echo)

12. • Echo represented as a dot
• Strength of echo is depicted by
brightness of dot
• Coalescence of multiple dots on
screen forms 2D representation of
examined tissue section

14. Gain
• Measured in decibels
Higher gain –
Display weaker echos
like vitreous opacities
Lower gain
Stronger echoes
(retina and sclera)
Better resolution

15. *Difficult clinical examination.
* Uncooperative patient.
* To assess extent of intraocular injuries.
TIP 2: WHEN TO DO A B SCAN?
Indications

16. Opaque Ocular Media
• Anterior segment:
Corneal opacity, pupillary membrane, hyphema/hypopyon,
dense cataracts, small/non-dilating pupil
• Posterior segment:
Vitreous hemorrhage, Vitritis, Retinal detachment,
Intraocular foreign body (IOFB) location, trauma

17. Clear Ocular Media
• Anterior segment:
Diagnosis of iris and ciliary body tumours
• Posterior segment:
Retinal detachment: exudative/rhegmatogenous
Intraocular tumours: size, location, dimensions, follow-up
Optic disc anamolies
Choroidal detachment (serous vs hemorrhagic),
posterior scleritis
• Ocular trauma / IOFB

18. TIP 3:
KNOW YOUR INSTRUMENT
Probe parts & orientation

19. PARTS OF THE PROBE Probe marker

20. PROBE ORIENTATION

22. • Axial:
Lesion in relation to lens &optic nerve .

24. VERTICAL AXIAL
Marker points superiorly
HORIZONTAL AXIAL
Marker points nasally

25. Transverse:
Lateral extent, 6 clock hours .

26. Marker points nasally

27. Longitudinal:
AP extent,1 clock hour.

28. • Shifting the probe away from the limbus with the same probe orientation (towards centre of
cornea)–ask patient to look more medially –more anterior scans

29. • A routine screening B scan includes:
 4 transverse scans (scanning superior, nasal,
inferior, and temporal retina)
 2 axial scans (Horizontal and vertical)

31. TIP 4 :
DIFFERENT EXAMINATION
TECHNIQUES

32. • Reclining or supine position
 Sitting position: silicon oil or gas filled eye
check for shifting fluid in exudative detachments
• Probe placed over conjunctiva or cornea or with eyelids closed
• Coupling jelly used with probe
• Image documentation: Stationary & Dynamic

33. TIP 5:
WHAT IS NORMAL?

35. Echotexture of
Lesion
Dot like lesions:
vitreous floaters, vitreous
hge, vitreous exudates.
Membranous lesions:
vitreous membranes, PVD,
RD
Mass lesions:
choroidalor retinal tumors

36. Multiple homogenous
densely medium to
high reflective dots
clear space between it
and retina
1ST
ASTEROID
HYALOSIS

37. Multiple low reflective
mobile dot echoes
low amplitude spikes
2nd
VITREOUS
HEMORRHAGE
 Organization of hemorrhage –membranous opacities with higher reflectivity
 Dense hemorrhage-increase in opacities with higher reflective echoes
 Clinical correlation is also important

38. Low reflective membranous echo
•Incomplete-attached to the ONH
•Complete-freely mobile, not attached
to ONH
PVD
3rd

39. similar echogenic to VH
• Loculations
• retinochoroidal thickening
ENDOPHTHALMITI
S/VITRITIS
4TH

41. 5TH
RRD

42. Tractional: concave with areas of traction
Exudative: shifting fluid

43. CHOROIDAL
DETACHMENT
6TH
• Smooth, dome shaped
• High reflective membrane
• Not attached to optic disc
• No mobility
• Double high spike called M spike

44. Serous:
Echolucent space behind membrane
Hemorrhagic:
Multiple moderate to high reflective dot echoes
behind membrane

45. PVD VS RD VS CD

46. CHOROIDAL
MELANOMA
7TH
• Low to medium echoes
•Regular internal structure
•Collar stud pattern
•Acoustic hollowing
•HEIGHT: Sound beam is perpendicular to tumour apex and inner sclera at tumor base
•BASE (Both transverse and longitudinal scans) measured

47.  Dense bright opacity with acoustic
shadowing
 Extremely high reflective echo
 Persist in low gain setting(20 DB to 30 DB)
IOFB
8TH

50. T-sign
•Fluid accumulation in Sub-Tenon's space
•hypoecholucent area continuous with ONH
POSTERIOR
SCLERITIS
9TH

51. Speed of sound in
silicone oil is slower than
vitreous
(Eye appears longer
than normal)
5TH
SFE

54. HOW TO REPORT
A SCAN?

55. Eye
Position
sitting/supine/prone
Lens/IOL reverberation/Anterior reverberation echoes
Vitreous/ Vitreous cavity (Compare both eyes)
Retina status
Choroid status
Optic nerve shadow
Axial Length (Compare both eyes)

56. Examples from
our cases by
B-scan
Ultrasound

57. Male patient of 45 years old was exposed to
blunt trauma 2 years ago .. Clinical
examination show traumatic cataract
B-scan US show rupture of posterior
capsule which cant be detected by clinical
examination

58. A case with Vit. Hge that couldn't be detected
clinically due to corneal oedema

59. A case with RD

60. Retinal break
could be
localized only
by US

63. A case with PVD
Mobility of PVD is more than RD.
PVD becomes more prominent in higher gain settings

64. A case with retinal tear without
detachment

65. A case with posterior lens dislocation

66. A case with PCIOL dislocation

68. A case with optic nerve avulsion
Retinal step sign from an edematous retina to bare sclera.

69. Always interpret B scan along
with corresponding A scan
•Clinical correlation is a must!

70. • Hope I have made ultrasound B scan of the
posterior segment easier to understand!