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Vol.18, No.

6 June 1996 V

Continuing Education Article

Ultrasonography
FOCAL POINT
of the Eye*
★ Ultrasonography is a safe, Louisiana State University Ohio State University
noninvasive way to evaluate the
intraocular and retrobulbar tissue Jamie Williams, MS, DVM David A. Wilkie, DVM, MS
of opaque eyes.

KEY FACTS
■ Transpalpebral ultrasonography
R outine ophthalmic examination involves direct visualization of adnexal
and intraocular structures. Opacity of the transmitting medium (e.g.,
cornea, aqueous humor, lens, or vitreous body) impairs ophthalmic ex-
amination. In such instances, ultrasonography can be used to complete the
evaluation.
may be the only way to examine
Ophthalmic ultrasonography was first applied by Mundt and Hughs in
the eye if the eyelid is severely
1956; they used amplitude (A-mode) technology.1 In 1958, Brum and Green-
swollen.
wood investigated the use of brightness (B-mode) ultrasonography for exami-
nation of ocular and orbital structures.2
■ A stand-off pad or extra coupling
Since then, ultrasonography has proved to be valuable in the examination of
gel can be used to place the
opaque eyes (i.e., when routine biomicroscopic or indirect ophthalmoscopic
image of the anterior chamber
examination is impossible). B-mode scan ultrasonography presents a two-
below the near-field reverberation
dimensional image of the tissue.3 Indications for ultrasonographic examination
artifact.
include ocular trauma, the need to measure axial length, intraocular or orbital
foreign bodies or masses, intraocular hemorrhage, lens luxation, retinal detach-
■ Sedation may cause extension
ment, and any opacity that prevents complete ophthalmoscopic examina-
of the nictitating membrane
tion.1,2,4–8 Ophthalmic ultrasonography has become part of the routine presur-
or rotation of the globe.
gical examination for intraocular and retrobulbar procedures in small and large
animals at the Ohio State University Veterinary Teaching Hospital.
■ Some horses require sedation
and an auriculopalpebral nerve
block, in addition to topical
PATIENT PREPARATION
The equipment required to perform ophthalmic ultrasonography includes an
anesthetic, for ophthalmic
ultrasound machine with an appropriate transducer (7.5- or 10-MHz), sterile
ultrasonography.
acoustic coupling gel, topical ophthalmic anesthetic, and some form of sterile
eyewash. Images should be recorded for later reference and included in the pa-
■ Bone, metal, or large quantities
tient’s permanent record. The easiest way to preserve the images is to record
of gas may make it difficult to
them on thermal paper or radiographic film; however, a videotape may also be
visualize ocular lesions
used. Images presented in this article are reproductions of images stored on
ultrasonographically.
radiographic film.
A topical ocular anesthetic (0.5% proparacaine hydrochloride) is applied to
the cornea. Manual restraint is sufficient for ultrasonographic ophthalmic ex-
amination of most small animals. Sedation should be avoided because it may
*A companion article for veterinary technicians appeared in the June 1996 (Vol. 17,
No. 6) issue of Veterinary Technician®.
Small Animal The Compendium June 1996

cause elevation of the nicti- TRANSDUCER AND


tating membrane and ro- SETTINGS
tation of the globe, thus It is best to use a sector
interfering with thorough scanner with a small scan-
examination.8 Some horses, head diameter (footprint) to
however, require sedation facilitate optimal placement
and an auriculopalpebral on the patient’s eye. Trans-
nerve block, in addition to ducers are available in a
topical anesthetic, to facili- wide range of frequencies3;
tate examination. however, a 7.5- or 10-MHz
Sterile coupling gel facili- probe is recommended for
tates transmission of sound ophthalmic ultrasonogra-
from the transducer into the phy.
optic tissue; therefore, a lay- Transducer frequency is
er of sterile coupling gel is inversely proportional to the
placed between the patient wavelength of the sound
and the transducer. If the Figure 1A beam. 3,11 Depth of sound-
transducer is to be applied beam penetration is propor-
to the cornea instead of to tional to wavelength.3 Axial
the eyelid, sterile coupling and lateral resolution have a
gel is applied directly to the significant effect on the
anesthetized cornea. Cellu- quality of the resulting im-
lose-based gels may be abra- age. 3 Axial resolution is a
sive and should be avoided function of pulse length.
to reduce the risk of corneal Lateral resolution depends
irritation. Applying the trans- on beam width, distance
ducer directly to the gel- from the transducer, and
coated cornea provides a size of the transducer face
better image of the posterior (footprint).3,11,12 A 10-MHz
globe and retrobulbar tissue transducer provides superior
than does transpalpebral ul- resolution but less depth of
trasonography.9 penetration than does a 7.5-
Some equine patients, MHz transducer. 3,7,8,11,12 A
however, do not tolerate ap- good rule of thumb is to use
plication of the probe to the Figure 1B the transducer of the high-
cornea. Transpalpebral imag- Figure 1—Ultrasonographic images of the eye of a healthy est frequency that will allow
ing is used for these pa- cat. Extra coupling gel was used as a stand-off. (A) Image visualization of the deepest
tients. To avoid trapping air obtained with a 7.5-MHz transducer. The cornea and tissue of concern.
(which is a barrier to ultra- most of the anterior chamber fall within the transducer ar- The focal range of a 7.5-
sound) between the trans- tifact zone. Only the axial anterior and posterior lens cap- MHz transducer is 2 to 5
ducer and the patient, the sules are seen in the noncataractous lens. (B) Image centimeters. This transducer
palpebral hair should be re- obtained with a 10-MHz transducer. The cornea and can produce good images of
moved or thoroughly wetted aqueous humor are easily seen below the transducer arti- eyes of small2,4,7,9,11 or large4
before the acoustic gel is ap- fact zone. C = cornea, I = iris, L = lens, VIT = vitreous animals. The 7.5-MHz
body, and ON = optic nerve.
plied. transducer provides better
Exposure of intraocular depth of penetration than
contents to the coupling gel does the 10-MHz probe,
should be avoided. Transpalpebral ultrasonography but the anterior segment is lost in the near-field rever-
may therefore be necessary to examine eyes that have beration artifact (Figure 1A).6–8 This problem can be at
traumatic lesions (e.g., corneal laceration or uveal pro- least partially overcome by the use of a tissue-equivalent
lapse). 10 If the eyelids are severely swollen, trans- stand-off pad.6–8 However, stand-off pads may produce
palpebral ultrasonography may be the only possible linear reverberations that can become superimposed
means of ophthalmic examination. over the image, thus complicating the interpretation.3

AURICULOPALPEBRAL NERVE BLOCK ■ TRANSPALPEBRAL IMAGING ■ TRANSDUCER


The Compendium June 1996 Small Animal

thalmic ultrasonography
have not been reported to
occur in animals. Neverthe-
less, the transducer power
should be kept at or below
20% when eyes are being
imaged. Higher power set-
tings unnecessarily subject
the choroidal tissue and vas-
culature to increased pulses
of ultrasound energy.
Setting the time-gain
compensation too high un-
necessarily amplifies weak
signals. Electronic amplifi-
Figure 2—Correct placement of the transducer on the cornea (left) and the resulting ultra- cation of background noise
sonographic image (right). results in a diffuse scatter-
ing of hyperechoic signals
throughout the image. 15
Another option is to apply This amplification may
excess sterile coupling gel to cause a false impression of
the cornea and decrease the degeneration of the vitreous
pressure applied with the body.16
transducer, thus allowing the
gel to act as a stand-off.13 Ei- EXAMINATION
ther method places the im- Each eye is imaged in ver-
age of the cornea and anteri- tical and horizontal planes
or segment of the globe through the visual axis for a
deeper on the screen, away complete examination. Each
from the near-field artifact view is optimized through
zone. Transpalpebral imag- minor adjustments in trans-
ing in horses may provide a ducer angle to obtain an op-
similar effect. timal image. Images of the
A 10-MHz transducer has right and left eye may then
a focal range of approxi- be compared for abnormali-
mately 3 to 4 centimeters.14 Figure 3A ty or asymmetry. After ex-
Depth of penetration is ade- amination, each eye is gen-
quate for thorough visual- tly flushed with eyewash or
ization of retrobulbar tissue. sterile saline to remove the
The 10-MHz transducer coupling gel and associated
provides better resolution debris.
than does the 7.5-MHz
transducer. Although the NORMAL FINDINGS
cornea may be lost in the The cornea is represented
near-field artifact zone, as a curved hyperechoic in-
more of the anterior cham- terface immediately below
ber will normally be visual- the transducer artifact zone
ized (Figure 1B). Visualiza- if a stand-off pad or addi-
tion of the anterior segment tional coupling gel has been
can be improved with the Figure 3B used (Figure 2). The an-
use of a stand-off pad or ad- Figure 3— (A) Ultrasonographic image (10 MHz) and echoic anterior and poste-
ditional coupling gel. (B) schematic of a normal equine eye. The hyperchoic corpo-
Adverse effects from oph- ra nigra extend from the dorsal pupillary margin of the iris. rior chambers are located
between the cornea and the

FOCAL RANGE ■ DEPTH OF PENETRATION ■ MACHINE SETTING


Small Animal The Compendium June 1996

TABLE I hypoechoic conus.


Normal Anterior-to-Posterior Dimensions of the Eye Table I lists biomet-
ric values.
Dimension (mm)
Dog 13 ABNORMALITIES
Abnormalities are
Structure Mesocephalic Dolichocephalic Cat 17 Horse Cow 17 classified according
to whether they in-
Lens 7.6 7.6 7.5–7.8 12.0–12.617 12.5 volve the anterior
11.91 segment, posterior
segment, or retrobul-
Globe 19.6 21.0 21.0 43.717 35.3 bar or periorbital tis-
39.41 sue. They may be
further categorized
Posterior lens 8.8 9.6 24.717 18.3 as hypo- or hyper-
surface to retina 17.41 echoic, invasive or
noninvasive, solid or
cystic. Cystic and
anterior lens capsule. The axial anterior and posterior solid masses within the globe or in periocular tissue
capsule of the lens are visualized. have been imaged.2,4,13,18–20
The equator of the lens capsule, however, cannot be A pigmented lesion in the anterior uvea might be a
visualized ultrasonographically because it is parallel or uveal cyst or an intraocular melanoma.8,21 Differentia-
nearly parallel to the sound beam; waves reflecting from tion of these lesions is critical because uveal cysts are
such surfaces miss the transducer and are therefore not benign and do not require treatment. A free-floating
imaged.3,6–8,14,15 The equatorial borders of the lens may pigmented mass or a light-transmitting mass is consid-
be evaluated by altering the transducer placement on ered to be a cyst because these characteristics are not as-
the cornea so that these borders are more perpendicular sociated with neoplasia.21 However, masses that remain
to the incident angle of the sound wave.6 attached or that fail to transmit light may be either
The normal lens cortex and nucleus are anechoic.6–8 cysts or melanoma. These masses can be distinguished
The ciliary apparatus is the echogenic structure at the with ultrasonography and histopathology.
lens equator. In horses, because their eyes are large, the Ultrasonographically, a cyst is a round, anechoic, ul-
iris and corpora nigra (Figure 3) may also be seen. The trasound-transmitting structure. Acoustic enhancement
corpora nigra are represented as an echogenic mass ex- of the far wall and deeper structures implies a fluid-
tending into the anechoic aqueous humor from the filled structure.3,15 Intraocular melanoma, in contrast, is
dorsal pupillary margin of the iris. usually a solid lesion with internal echogenicity and
Anechoic vitreous body separates the posterior lens without ultrasound transmission.8 Because cysts and
capsule from the echogenic posterior eye wall. In an melanoma arise from the anterior uvea, a stand-off pad,
ultrasonographic image of a healthy eye, the retina, extra coupling gel, or transpalpebral imaging may be
choroid, and posterior sclera are not depicted as sepa- required for thorough examination.
rate layers.6–8 The optic disk appears as a focal hyper-
echoic structure with a posterior hypoechoic area at the Anterior Segment
choroidal surface of the posterior eye wall. The triangu- Abnormalities of the anterior segment most com-
lar conus is the hypoechoic region that narrows as it ex- monly involve the iris, ciliary body, or lens. Masses of
tends from the posterior sclera into the deeper, more the iris and ciliary body include cyst, tumor, and in-
echogenic retrobulbar musculature and fat. The conus flammatory granuloma. The most common intraocular
contains the optic nerve, vessels, and retrobulbar fat. neoplasm is lymphosarcoma22; however, primary tu-
An optimal image (Figure 1B) contains the hyper- mors of the anterior segment are most often melanoma,
echoic cornea and anechoic aqueous humor superficial- adenoma, or adenocarcinoma.8 The size of the apparent
ly. The thin hyperechoic anterior and posterior lens re- mass can be measured on the ultrasonographic image,
flections with the echogenic ciliary body are superficial thus enabling the clinician to monitor response to ther-
to the anechoic vitreous body. Deep to these structures apy or progression of disease during subsequent exami-
are the echogenic choroid and retina with the central nations.
hyperechoic optic disk. Deeper still is the triangular, In eyes with cataract, the entire lens capsule is visual-

UVEAL CYST ■ MELANOMA ■ INFLAMMATORY GRANULOMA


Small Animal The Compendium June 1996

ized ultrasonographically as and location relative to the


a relatively smooth hyper- iris and posterior eye wall.
echoic structure with or with- Lens luxation may be readi-
out intralenticular hypere- ly visualized (Figure 6) and
chogenicity (Figure 4). The classified as anterior or pos-
axial anterior–posterior di- terior luxation on the basis
mension of the lens may be of biometric measurements
increased (intumescence) (posterior lens capsule to
because of imbibition of flu- posterior eye wall; Table I).
id. An acquired decrease in Careful examination and in-
the anterior–posterior axial terpretation of increased dis-
dimension of the lens occurs tance between the posterior
with resorption of the lique- lens and posterior eye wall is
fied cortical material in hy- necessary to differentiate an-
permature cataracts. terior lens luxation from
Microphakia (congenitally Figure 4—Ultrasonographic image (10 MHz) of the left eye rupture of the posterior as-
small lens) may occur as a of a 1-year-old male bichon frise with a cataract. The lens pect of the globe.
solitary lesion or may be as- capsule is completely echogenic, and there is a slightly hy-
sociated with other congeni- perechoic intralenticular signal. There is no retinal detach- Posterior Segment
tal intraocular abnormali- ment. Vitreous Body
ties. Measurements of the If the time-gain compen-
anterior–posterior dimen- sation is properly set, multi-
sion of the globe are impor- focal hyperechoic interfaces
tant in many instances (e.g., (signals) within the normal-
determining placement of ly anechoic vitreous body
an intraocular implant). indicate hemorrhage, syner-
Perilenticular inflammato- esis (degeneration of the vit-
ry exudate may accompany reous body), or asteroid
anterior uveitis (especially if hyalosis. As mentioned, set-
the uveitis results from a ting the time-gain compen-
granulomatous disease), thus sation too high creates a
resulting in a fuzzy hypere- false impression of hyper-
choic border at the periph- echogenicity in the posterior
ery of the lens capsule (Fig- segment.
ure 5). Inflammatory material Liquefaction of the vitre-
(e.g., fibrin and hypopyon) ous body is a decrease in the
may accumulate in the ante- hyaluronic gel and an in-
rior chamber as a result of crease in the free water con-
anterior uveitis. In a nono- Figure 5— Transpalpebral ultrasonographic image (10 tent of the vitreous body.
MHz) of a cat with feline infectious peritonitis. Note the
paque eye, this material is thickened, fuzzy hyperechoic lens capsule. The linear This shift in composition
usually evident with pen- hyperechoic band extending caudally from the posterior results in focal changes in
light examination of the an- lens capsule is a fibrin strand. A persistent hyaloid artery acoustic impedance, thus
terior segment, but severe may have a similar appearance if enough inflammatory ex- leading to the focal hyper-
anterior uveitis may be asso- udate is present. echoic signals seen in cases
ciated with diffuse corneal of syneresis (Figure 7).
edema, thus making ultra- Asteroid hyalosis is the
sonographic examination necessary. Fibrin causes floc- formation of calcium and phospholipid crystals within
culent hyperechogenicities throughout the anterior the vitreous body, thus resulting in discrete areas of hy-
chamber, whereas hypopyon typically occurs more ven- perechogenicity. The significance of syneresis in ani-
trally and is more uniform in echogenicity.22 mals is not well defined; however, its presence may pre-
Lens luxation or cataract may result from trauma. It dispose the animal to retinal detachment.23 Asteroid
is important to evaluate the lens of hyphemic eyes for hyalosis, which is common in old dogs but rare in hors-
internal opacities (traumatic or preexisting cataract) es and cats, is generally not clinically significant.

CATARACT ■ ANTERIOR UVEITIS ■ LENS LUXATION ■ SYNERESIS


The Compendium June 1996 Small Animal

The vitreous body may detachment may elevate


also be evaluated for signs only a portion of the retina
of hemorrhage (Figure 8). and may appear as only one
Hemorrhage in the vitreous hyperechoic strand of the
body implies poor prognosis gull-wing or V-shaped de-
because it indicates damage tachment. If the retina is
to the ciliary body, retina, or also detached from the cil-
choroid 24 (e.g., persistent iary body, it may be dis-
hyaloid artery). Ultrasono- placed and folded on itself,
graphically, hemorrhage thus appearing as an echo-
may be anechoic, hypo- genic or hyperechoic fold
echoic, or hyperechoic, de- near the optic disk.
pending on duration and Hemorrhage between the
organization or clot forma- retina and vitreous body can
tion. Hemorrhage may oc- cause vitreal detachment,
cur between the vitreal body which may be misdiagnosed
and retina (thus leading to Figure 6—Ophthalmic ultrasonographic image (10 MHz) as retinal detachment. De-
vitreal detachment) or be- of a dog with posterior luxation of the lens. The lens is lo- tachment of the vitreous
tween the retina and poste- cated within the vitreous body, adjacent to the posterior body has been described as a
rior eye wall (thus resulting eye wall. Internal linear hyperechogenicities are secondary distinctive inward bulging at
in retinal detachment). to the traumatic luxation of the lens. the choroidal surface; the
bulging may not terminate
Retina at the optic disk as with reti-
Retinal detachment may nal detachment. Detach-
be associated with congeni- ment of the vitreous body
tal diseases or inherited dis- usually produces a much
orders, may be idiopathic, thinner, less well-defined
may result from inflamma- interface and may occur in
tion or systemic hyperten- conjunction with retinal de-
sion, may follow trauma or tachment. 26 In humans,
surgery, or may be associat- definitive diagnosis requires
ed with cataract.23 The inci- superimposition of an A-
dence of retinal detachment mode vector over the B-
increases directly with the mode scan. Detachment of
maturity of the cataract.5 the vitreous body presents a
Retinal detachment classi- single spike 30% to 50% as
cally appears as two well- tall as the reference peak,
defined linear or curvilinear whereas retinal detachment
hyperechoic structures with- Figure 7—Ophthalmic ultrasonogram (10 MHz) of an 8- forms a single spike equal to
in the vitreous body and ex- year-old spayed Maltese. The classic gull-wing hyperechoic the reference peak height.27
tending from the optic disk detached retina extends into the vitreous body from its at-
tachment at the optic disk. Note the echogenic vitreal de-
toward the ora ciliaris reti- bris (syneresis) between the strands of the detached retina. Posterior Eye Wall
na.6–8,25 This condition usu- Rupture of the posterior
ally presents a gull-wing or eye wall (Figure 8) may oc-
V-shaped appearance within the vitreous body (Figure cur in any animal but is more common in large animals
7). Anechoic or hypoechoic signals usually separate the and is often secondary to blunt trauma. Ultrasono-
linear hyperechoic retina from the posterior of the graphically, rupture of the posterior eye wall appears as
globe. a uniform echogenicity extending from the vitreous
An anechoic subretinal space suggests the presence of body to the retrobulbar tissue, without distinct visual-
noncellular fluid (e.g., transudate), which may eventu- ization of the posterior eye wall. This appearance is due
ally be resorbed.24 An echogenic subretinal space may to the hemorrhage extending from the vitreous body
indicate hemorrhage, inflammation, or neoplasia,25 thus into the retrobulbar tissue, through the damaged fi-
resulting in a less-favorable prognosis.24 Partial retinal brous tunic that was the posterior eye wall.

HEMORRHAGE ■ RETINAL DETACHMENT ■ RUPTURE


Small Animal The Compendium June 1996

Retrobulbar or sound beam contacts any


Periorbital Tissue highly reflective interface
Evidence of periorbital or and is almost completely re-
retrobulbar disease is an in- flected back to the transduc-
dication for ultrasonographic er. Dense cataracts may also
examination.2,4,6–8,20,28 Solid exhibit acoustic shadowing.
masses may be differentiated The stream of echoes that
from cysts, diffuse cellulitis, seems to trail from a small
or vascular anomaly. 6,14,20 quantity of gas is called a
Retrobulbar masses may be comet-tail reverberation arti-
diffuse or discrete and may fact.3,11 Large accumulations
or may not deform the of gas resemble bone or met-
globe.4 Retrobulbar inflam- al, with a hyperechoic signal
mation is usually diffuse, and strong acoustic shadow-
whereas masses are more ing.15 Combinations of these
often discrete. Discrete Figure 8—Transpalpebral ultrasonogram (10 MHz) of the images may be seen in pene-
masses that deform the traumatized eye of a mature dog. The echogenic aqueous trating wounds of the eye.
globe are generally believed humor is separated from the equally echogenic vitreous
to be neoplastic (Figure 9), body by the anechoic lens. The posterior eye wall is not vi- CONCLUSION
although a similar ultra- sualized, thus suggesting rupture of the globe. Rupture of Ultrasonography is excel-
sonographic image may be the globe was confirmed at surgery. lent for evaluating soft-tissue
produced by retrobulbar structures; however, bone,
abscess or disease of the zy- metal, or large quantities of
gomatic salivary gland. gas may obscure lesions. Be-
Retrobulbar abscess may cause ultrasound does not
be differentiated from a penetrate bone, ultrasonog-
retrobulbar cyst by its thick- raphy is poorly suited for
er, more irregular capsule evaluating complex or pene-
and more echoic central trating osseous changes. Ra-
region. 6,15,18 In one study, diography may better define
no ultrasonographic criteria a radiopaque intraocular or
were pathognomonic; how- periocular foreign body and
ever, diffuse nondeforming may more completely illus-
lesions were most compati- trate any secondary perior-
ble with retrobulbar celluli- bital changes. Ultrasonogra-
tis.4 phy may, however, more
An ultrasonographically completely pinpoint the lo-
guided fine-needle aspira- cation of the foreign body
tion or biopsy of retrobul- Figure 9—Ophthalmic ultrasonogram (10 MHz) of an 8- before intervention. There-
bar or periorbital masses year-old castrated domestic shorthair with a retrobulbar fore, radiography should ac-
may provide useful diagnos- mass distorting the medial (nasal) aspect of the posterior company ultrasonographic
tic or prognostic informa- eye wall. The standard nasotemporal transducer angle has evaluation in cases of retro-
been adjusted to optimize the distortion of the globe. Fi- bulbar disease, ocular or peri-
tion. If the mass is solid, tis-
brosarcoma was diagnosed by examination of fine-needle
sue or cells may be obtained aspirate. ocular penetrating wounds,
for cytologic evaluation and or suspected foreign bodies.
culture. If the lesion is cys- In patients with ocular
tic, the fluid may be drained and submitted for analysis trauma, information derived from ultrasonographic ex-
and culture. amination helps determine the extent and severity of
Ultrasonography is often helpful in identifying in- the injury. It also helps provide a more accurate prog-
traocular, periorbital, or retrobulbar foreign bodies. nosis and aids in the selection of treatment. Ultra-
Bone or metal are hyperechoic and produce an an- sonography may be the only useful way to examine an
echoic shadow in the tissue immediately deep to eye that is severely painful or opaque. Ultrasonographic
them.3,15 This acoustic shadowing occurs when the ultra- measurements of identifiable structures may also be

RETROBULBAR ABSCESS ■ FOREIGN BODY ■ ARTIFACTS


Small Animal The Compendium June 1996

beneficial in assessing damage and identifying lens lux- toon JS, Nyland TG (eds): Veterinary Diagnostic Ultrasound.
ation or rupture of the globe. Philadelphia, WB Saunders Co, 1995, pp 178–197.
9. Hager DA, Dziezyc J, Millichamp NJ: Two-dimensional
To evaluate ultrasonographic changes in ocular and real-time ocular ultrasonography in the dog: Technique and
periocular tissue, the veterinarian must have a thorough normal anatomy. Vet Radiol 8:60–65, 1987.
understanding of normal ocular anatomy and measure- 10. Regnier A, Toutain PL: Ocular pharmacology and therapeu-
ments. A basic knowledge of ultrasonography and ul- tic modalities, in Gelatt KN (ed): Veterinary Ophthalmology.
trasonographic artifacts, combined with a knowledge of Philadelphia, Lea & Febiger, 1991, pp 162–194.
11. Herring DS, Bjornton G: Physics, facts, and artifacts of di-
ophthalmic disease, is also necessary. For patients with- agnostic ultrasound. Vet Clin North Am Small Anim Pract
out opacity of ocular transmitting media, ophthalmic 15:1107–1122, 1985.
ultrasonography is an excellent companion to, not a re- 12. Rantanen NW, Ewing RL III: Principles of ultrasound ap-
placement for, routine complete ophthalmic examina- plication in animals. Vet Radiol 22:196–203, 1981.
tion. For animals with opaque or painful eyes or severe- 13. Cottrill NB, Banks WJ, Pechman RD: Ultrasonographic
ly swollen eyelids, however, ultrasonography may be and biometric evaluation of the eye and orbit of dogs. Am J
Vet Res 50:898–903, 1989.
the most readily available and cost-effective means of 14. Dziezyc J, Hager DA: Ocular ultrasonography in veterinary
ophthalmic examination. B-mode ultrasonography is medicine. Semin Vet Med Surg (Small Anim) 3:1–9, 1988.
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16. Coleman DJ, Jack RL, Franzen LA: High resolution B-scan
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About the Authors thalmol 88:358–367, 1972.
Dr. Williams is affiliated with the Department of Veteri-
17. Samuelson DA: Ophthalmic embryology and anatomy, in
Gelatt KN (ed): Veterinary Ophthalmology. Philadelphia, Lea
nary Clinical Sciences, School of Veterinary Medicine, & Febiger, 1991, pp 3–122.
Louisiana State University, Baton Rouge, Louisiana. 18. Miller WW, Cartee RE: B-scan ultrasonography for the de-
Dr. Wilkie is affiliated with the Department of Veteri- tection of space-occupying ocular masses. JAVMA 187:66–
nary Clinical Sciences, College of Veterinary Medicine, 68, 1985.
Ohio State University, Columbus, Ohio, and is a Diplo- 19. Schoster JV, Dubielzig RR, Sullivan L: Choroidal melanoma
in a dog. JAVMA 203:89–91, 1993.
mate of the American College of Veterinary Ophthal-
20. Davidson HJ, Blanchard GL: Periorbital epidermoid cyst in
mologists. the medial canthus of three dogs. JAVMA 198:271–272,
1991.
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