Beruflich Dokumente
Kultur Dokumente
6 June 1996 V
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
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
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
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Vet Res 50:898–903, 1989.
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ophthalmic examination. B-mode ultrasonography is medicine. Semin Vet Med Surg (Small Anim) 3:1–9, 1988.
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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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