Sonography of the orbit

1. Sonography of the orbit By DR MARYAM FARGHADANI RADIOLOGIST

2. Indications • 1• Opacity of light-conducting media, making direct vision by • ophthalmoscopy difficult • 2• Suspected intraocular tumour-solid lesions are readily • diagnosed, sited and measured by ultrasound • 3• Differentiation of serous and solid retinal detachment; a detachment • may conceal a tumour-the subretinal area is clearly • demonstrated by ultrasound • 4• Examinationof the vitreous • 5• Localisation of foreign bodies • 6• Ocular measurements (biometry by calibrated A-scan) • 7• Proptosis (CT and MRI are usually more helpful) • 8• Doppler investigation of orbital vascular disease and tumours.

3. Patients with opaque light-conducting media form the majority • of referrals, especially those with cataracts and haemorrhages. It is • not necessary to scan every patient with a cataract, but if other • symptoms develop, for example inflammation, pain, rapidly worsening • vision or the development of glaucoma, then a scan must be • performed to determine any coexistent pathology. • When vitreoretinal surgery is contemplated, ultrasound assessment • of the globe is mandatory. The information required includes: • • The state of the vitreous • • The position and extent of any intraocular lesion visible by • ultrasound • • The condition of the retina, and particularly the macula • • The mobility of the contents of the globe, which has a direct • influence on operability • • The relation between the vitreous and retina, mapping out any • vitreoretinal adhesions.

12. RETINA • Retinal detachment • Acquired retinoschisis • Disciform lesions • Drusen(hyalin bodies)

13. Retinal detachment

14. Retinal tear

15. Retinal detachment and transvitreal membrane

16. Disciform lesions

17. retinoschisis

18. Drusen

19. Chroidal detachment

20. Subchroidal hemorrhage

21. vitreous • Persistanthyperplastic primary vitreos • Vitreous hemorrhage • Asteroid hyalosis • Posterior vitreous detachment

22. PHPV

23. Dense vitreous haemorrhage arranging into thick mobilefibrinous membranes

24. Subvitreal haemorrhage in a diabetic

25. Asteroid hyalosis

26. PVD, eye deviated to right and left side

27. Ocular tumors

28. 45-year-old woman with ciliary body melanoma. Sonogram shows tumor is large and round, which is common for melanoma.

29. Color Doppler sonogram shows blood vessels encircling and penetrating tumor.

30. 62-year-old man with melanoma arising from ciliary body, which is small and buttonlike. Small melanoma of ciliary body can be missed because of its small size and location if funduscopy is performed without depressing sclera externally.

31. Complications of melanoma in 69-year-old woman with diminished brightness of vision. Vitreous hemorrhage, seen as low-level echoes filling vitreous body (V), completely obscures direct view of tumor (arrow) by funduscopy.

32. Complications of melanoma in 42-year-old man with severe loss of vision in one eye. Location of melanoma (large arrow) on and adjacent to optic disk (small arrows) may prevent radiation treatment and could necessitate enucleation of eye.

35. conclusion

36. Sonography of the eye shows a variety of diseases with remarkableclarity. The technique is more cost-efficient than other diagnostictechniques and is welltolerated by the patient. We have experiencednolimitations and have received no complaints from patients.We do not advocate the routine use of sonography in the asymptomaticeye, but it may serve as a useful extension of the initial investigationof the symptomatic patient.

37. Thank you for your attention