6. Plain Radiography
Primary procedure of choice in the
assessment of trauma, including
evaluation of foreign bodies.
Standard skull projections:
• Posteroanterior.
• Lateral.
• Half axial (Towne’s) views.
• An optic canal view may be useful in to
evaluate the optic canal and fissures.
7. Optic nerve glioma
Large right canal, confirming extension
of tumor to this portion of the nerve.
8. Dacryocystography
Used in the evaluation of congenital and acquired
disorders of the lacrimal drainage apparatus.
After cannulation of the superior and inferior punctum
with a small bore rounded tip needle, water soluble
contrast medium is injected into the canaliculus
during fluoroscopy, with subtraction images obtained
to improve visualization of subtle pathology.
Intubation of both sides is done simultaneously due to
high incidence of bilateral anomalies.
The canaliculi fill initially followed by the lacrimal sac,
with subsequent opacification of the nasolacrimal
duct.
Spill into nasal cavity indicates patency of the
drainage system.
10. Angiography
Rarely used.
It is performed principally on those
patients with suspected or proven vascular
anomalies of the orbit or middle cranial
fossa such as carotid cavernous fistula or
dural AV malformation.
Both diagnostic and therapeutic
interventions may be carried out.
11. Carotid-cavernous fistula
Right internal carotid artery injection (straight arrow),
lateral view, opacifies cavernous sinus (curved arrow)
as well as dilated superior ophthalmic vein
(arrowhead). Note absence of filling of internal carotid
circulation.
12. ULTRASOUND
Ultrasound examination of the eye give an
accurate 2D representation of the normal
anatomic structures.
The cystic structure and superficial position make
the eye ideal for ultrasound examination.
ADVANTAGES:
Rapidity and accessibility, cost effective, no
radiation, can do dynamic study.
13. Computed Tomography (CT)
CT scans are preferred in cases of proptosis and trauma.
Easy availability and speed.
Better evaluation of bony lesions.
Subtle or small calcifications are well shown.
Iodinated contrast media may be used to assist in
characterizing the mass.
CT scans should be performed with contiguous thin (2-
3mm) sections axial and thicker (4-5mm) coronal images,
displayed in both soft tissue and bone window.
3D reconstruction by spiral CT may be used.
LIMITATIONS:
Radiation hazards.
Reaction to contrast media.
Limited multiplanner capability.
Can not do dynamic study.
14. CT: Trauma
Medial blow-out fracture.
Partial herniation of medial rectus muscle and
orbital fat into left ethmoidal air cells through
fractured lamina papyracea.
15. Ruptured globe
Opacification of ethmoids with blood and fluid secondary to
extensive comminuted fracture of lateral orbital wall
(arrows).
Hyper dense blood fills ruptured and misshapen left globe.
There is contusion of retro-orbital fat as well as preseptal
soft tissue swelling.
16. Carotid cavernous fistula
Enhanced axial CT image demonstrates enlargement
of right superior ophthalmic vein (arrow).
Engorgement of right medial rectus muscle as well as
elevation of choroid (arrowhead) by suprachoroidal
effusion resulting from orbital venous hypertension.
17. Drusen
CT shows bilateral punctate calcifications, located
centrally over optic nerve head.
18. MRI
ADVANTAGES:
• Lack of bony artifacts.
• Sensitivity in detection of subtle lesions.
• Procedure of choice in evaluation of visual loss or suspected
cranial nerve dysfunction. Complete evaluation should
include the entire course of the affected nerve, including the
brainstem, with use of intravenous contrast.
CONTRAINDICATIONS:
Patients with metallic foreign bodies, cardiac pacemakers,
aneurism clips, cochlear implants.
TECHNIQUE: MRI of the orbit should include both T1 and T2
weighted sequences and T1 weighted sequences with
intravenous contrast injection in axial, coronal and possibly
parasaggital planes.
The use of fat suppression combined with post contrast
sequences significantly improves visualization of subtle
masses and lesions of optic nerve.
Patient co-operation is required due to long scanning time
and to minimize eye movement during scan.
20. Dislocated lens
Axial T2W MR Image demonstrates dislocated
right lens within vitreous chamber.
21. Hemorrhagic retinal detachment
T1W MR image demonstrates elevation of retina by
hyperintense hemorrhage.
Retinal attachment anteriorly to the ora serrata and
posteriorly to the macula creates a characteristic V-
shaped configuration.
22. Encephalocele
Axial T1W MR image demonstrates marked proptosis
of right globe with stretching of attenuated right optic
nerve(arrowhead) due to herniation of dura and
temporal lobe through a large sphenoid defect.
23. Plexiform neurofibroma
T1W and T2W MR images demonstrate extensive left
temporal scalp lesion with extension to the left orbit
resulting in mild proptosis.
MR also demonstrates ectatic left optic nerve (arrow).
24. Optic nerve glioma
Enhanced fat saturated axial T1W image demonstrates
mild enhancement and enlargement of intra-orbital and
canalicular segments of left optic nerve as well as
dilated low signal intensity perioptic space.
Coronal image confirms enlargement of nerve and
surrounding perioptic space.
25. Choroidal melanoma
T1W and T2W MR images demonstrate well
circumscribed broad based lesion of posterior left
retina.
High signal intensity on T1W images and low signal
intensity on T2W images is due to characteristic
paramagnetic effect of melanin.
26. Retinoblastoma
Axial T1W and T2W MR images demonstrate full
extent of large lesion within left globe.
High signal intensity on T1W images, and low
signal intensity on T2W images is consistent
with the dense cellular nature of this tumor.
29. 2D IMAGING
TECHNIQUE:
Short focus 7.5MHz and 12MHz real time small
part sector transducers.
Patient lying supine.
Contact method- Probe directly placed on closed
eyelid with intervening coupling gel.
Complete visualization of the ocular structures
achieved with careful movement and orientation
of transducer with eye fixed in primary position
and in all directions of gaze.
30. NORMAL SONOGRAPHIC APPEARANCE
OF EYE
P- pupil
IR- iris
L- lens: Echogenic
convex body sitting
over vitreous body
SL-Suspensory
ligaments holding the
lens.
PS- posterior
segment
32. Normal sonographic appearance of eye
with retro-bulbar space
Normal eyeball with optic
nerve in long axis as a
hypoechoic strap
traversing through
Echogenic retro bulbar fat
33. COLOR FLOW IMAGING AND
DOPPLER STUDY
Highly useful in assessing vascular pathologies of
eye and orbit.
Ophthalmic artery.
Central artery of retina.
Short ciliary and posterior ciliary arteries supplying the
choroid.
Highly useful to examine intraocular tumours like
melanomas, retinoblastoma and metastasis.
Retinopathies.
Evaluation of non-vascularization of tumor and
infiltration in adjoining tissues.
35. SPECTRAL DOPPLER TRACING
Flow in the central
artery of retina
Short systolic and
prolonged diastolic flow in
the central artery of retina
typical of small arterial
flow pattern.
36. NORMAL CHOROIDAL FLOW
Central artery of retina
and its branches, short
and long posterior ciliary
arteries supplying the
choroid.
37. EXTRA OCULAR MUSCLES
Normal extraocular
muscles as hypoechoic
bands.
The medial and lateral
rectus muscles are seen on
nasal and temporal side.
Maximum normal thickness
of muscles is 3mm
38. INDICATIONS OF OCULAR
ULTRASOUND
All the pathological conditions where
direct ophthalmoscopy is not possible
are the indications for high-
resolution sonography (HRSG) of the
globe.
1. Congenital anomalies.
2. Acquired pathologies.
40. A young child borne with small orbital sockets and thin palpebral fissure.
HRSG shows bilateral agenesis of eyeballs with small palpebral fissure
in the orbital socket.
Irregular cystic spaces are seen in the orbits with small echogenic
retrobulbar fat.
Bilateral agenesis of eye
41. Cryptophthalmos
Right eye covered with a skin fold in an infant.
HRSG reveals a small cystic mass with absent lens and iris
in right orbit.
Normal left eye of the same patient.
42. Congenital cystic eye
Cystic mass seen over left orbit.
Left orbit shows two big cysts one in anterior part another
in retrobulbar part communicating with each other.
Normal left eye is absent.
43. Congenital cystic eye
Cystic mass seen over right orbit.
HRSG shows a small rudimentary cystic eye which is
engulfed by a big orbital cyst.
Small amount of retrobulbar fat is seen posterior to the
rudimentary eye.
44. Persistent hyperplastic primary
vitreous (PHPV)
A young child was born with white eye reflex on ophthalmic
examination in left eye.
CT scan of the same patient shows thick lens in left eye
with small eye.
HRSG shows echogenic membranous vitreous with small
left eye. The embryonic vitreous did not develop into
normal transparent vitreous.
45. Persistent hyperplastic primary
vitreous (PHPV)
Small left eye with thick lens and an echogenic
band going from the lens and an echogenic
band going from the lens to the posterior pole.
Color doppler flow study shows echogenic band
having hyaloid artery.
47. Retrolental fibroplasia
HRSG shows a thick opaque lens with a posterior
membrane and an echogenic band going from the
membrane to the posterior pole in a newborn
child.
48. Bilateral drusens
Echogenic calcification seen at the optic disc in
both eyes.
Acoustic shadowing.
CT shows bilateral optic disc calcification.
49. Bilateral congenital cataract
An infant was born with white eye reflex in both eyes.
HRSG shows echogenic thickened opaque lens in both
eyes.
Posterior segment of the eye is free.
50. Retinopathy of prematurity
A baby was born with white eye reflex in both eyes.
HRSG shows echogenic membranous shadows filling the posterior
segment of the eye.
The eye is small in size.
Multiple cysts are seen in it.
No calcification is seen.
Color doesn’t show any flow in the retinal membrane.
52. Opaque ocular media
Anterior segment:
Corneal opacification.
Hyphema or hypopyon.
Miosis.
Cataract.
Pupillary or retrolental membrane.
53. Anterior chamber hyphema
HRSG shows echogenic collection in anterior chamber
in case of trauma to eye.
Echogenic collection is a blood in anterior chamber.
Associated cataract lens is also seen.
54. Bilateral congenital cataract
A young child presented with bilateral cataract.
HRSG shows thickened opaque lens in both eyes.
Right lens is 2.5mm in thickness and shows nucleus
calcification.
Left lens is 2.9mm in thickness.
Posterior segment of eye is free.
No integral pathology is seen.
55. Congenital cataract
HRSG shows thickened opaque lens in the eye. The
anterior chamber is also seen increased in depth.
The iris is thickened and irregular in outline s/o iritis
56. Post traumatic cataract
HRSG shows thickened opaque lens in left eye in case
of trauma.
Lens is 7.3mm in thickness.
Multiple intralenticular opacities are present.
Posterior segment of the eye is free.
57. Post traumatic cataract
HRSG shows markedly thickened opaque lens.
The nucleus is seen broken into multiple small
echogenic calcified dots.
Associated integral hemorrhage is also seen.
58. Calcified lens in posterior segment
HRSG shows thickened opaque lens with calcified
nucleus displaced in posterior segment.
The membranous ligaments holding the lens are also
seen as twin echogenic bands.
No integral hemorrhage is seen.
59. EXAMINATION OF VITREOUS
Transparent gel.
Normal: Echo-free cavity on HRSG.
Scattered opacities of low density noted in
aging eye due to degenerative changes.
Vitreous evaluation:
Assesment of vitreous body
Posterior hyaloid.
Subvitreal space.
Retina.
Choroid.
Sclera.
Optic disc.
60. Vitreous hemorrhage
Second most common cause of opaque
ocular media after cataract.
CAUSES:
Trauma.
Diabetic retinopathy.
Macular degeneration.
Vein occlusion
Retinal tear.
Intraocular tumours.
61. HRSG:
• The bright echoes of dots produced due to
clump or cells having blood.
• Small or subtle hemorrhage is difficult to see
on HRSG.
• Low intensity echoes are seen on high gain
setting.
• Medium to dens level echoes depending on
severity of hemorrhage.
62. FRESH INTEGRAL
HEMORRHAGE
Echogenic integral hemorrhage
confined to the subvitreal
space with layering of blood.
Dense echogenic collection
in vitreous cavity.
ORGANIZATION OF
HEMORRHAGE
63. Old hemorrhage
Old hemorrhage confined to
posterior segment of eye with
organization of blood.
HRSG shows membranous
vitreous retracted from its
surface and hanging from the
base.
Echogenic integral hemorrhage
with a thin membrane seen
detached from its surface and
folded forming a cyst s/o
posterior vitreous detachment.
Vitreous hemorrhage with PVD
64. POSTERIOR VITREOUS DETACHMENT
Focal.
Diffuse
Associated with
Synchysis senilis-A degenerative condition in which gel loses its
volume and becomes hypermobile.
Cataract.
Posterior hyaloid may separate completely from posterior pole.
It may remain attached to optic disc giving a funnel shaped
appearance.
On ‘ B-scan ‘ imaging PVD is usually smooth and may be thick
when blood is layered posteroinferiorly.
Real time HRSG shows an undulating movement in PVD. This
differentiates it from retinal detachment.
66. Pyophthalmos
Dense homogenous low
level collection filling
whole of the eyeball with
increased length of the
eyeball in a case of post-
traumatic pyophthalmos.
Color doppler study of the
same patient does not show
any vascularity with no
movement of the collection
s/o thick pyogenic collection.
67. Asteroid Hyalosis (Starry eye)
HRSG shows multiple bright
echogenic specks in the
posterior segment. Calcium
specks are seen as bright
dots. Dynamic study shows
movement of the dots.
Bright echoes are seen in
the posterior segment
arranged in a form of
galaxy. It gives typical
starry appearance.
68. Degenerative vitreous
Thick membranous vitreous seen with multiple fine
interlacing netting pattern forming dense net s/o
degenerative vitreous in a patient of glaucoma
involving both eyes.
69. Proliferative Vitreoretinopathy
HRSG shows typical triangle sign of PVR with multiple
vitreo-retinal bands and retinal cyst formation.
Color doppler study shows dragging of the vessels in
the triangle with typical triangle sign of PVR.
70. Subvitreal Hemorrhage
Associated with vitreous hemorrhage
or alone.
In mild subvitreal hemorrhage, very
high gain setting required.
Subvitreal blood usually does not
clot, therefore of low reflectivity and
mobile even in chronic cases.
71. Posterior Hyphema
Subvitreal hemorrhage has tendency to layer out
similar to anterior chamber hyphema.
The surface of this layered blood stands out as
smooth, dense echogenic membrane on b-scans.
With the kinetic movements of the eye this hyphema
normally slides across the fundus surface of eye.
In sitting upright position hyphema changes its
position in eye. This excludes underlying retinal
detachment or retinochoroid layer thickening.
The characteristic motion of vitreous and retina
normally differentiates their pathologies.
If posterior hyaloid surface is thickened and attached
to the optic nerve head, very careful monitoring and
observation are required to differentiate it from
detached retina.
73. Retina
One of the most important role of HRSG is in evaluating the
pathology of retina in opaque ocular media, retinal tears,
retinal detachments, retinoschisis and other disorders.
Retinal tears and retinal detachments can be easily
evaluated on HRSG.
Small retinal tears show flappy movements on dynamic
scanning.
They are usually present in superior peripheral fundus.
They may be associated with posterior vitreous detachment
but giant retinal tears show varied presentation and usually
associated with sever injury to eye.
When an unusual insertion of membrane is seen on HRSG
possibility of giant retinal tear is to be kept.
74. Retinal detachment
Retina is closely applied to choroid.
It is firmly attached at optic nerve head and
ora serrata giving a funnel shaped
appearance.
Retinal detachment (RD) typically produces
a bright continuous normally folded
membrane on B-scan.
RD shows little or more restricted
movement than PVD.
Long standing RD may develop retinal cyst.
It may be partially calcified and cholesterol
debris may accumulate in subretinal.
75. Types of retinal detachment
1. Rhegmatogenous RD: due to the break in the continuity of retina
due to the weakness in the peripheral retina due to degeneration
as in myopia, diabetic retinopathy or vitreoretinal traction in
detached vitreous.
2. Non-Rhegmatogenous RD:
a) Tractional RD- caused due to fraction of detached vitreous pulling the
retina from the pigmented epithelium through vitreo-retinal bands
resulting into angular or fix retinal detachment.
b) Exudative retinal detachment: caused due to collection of fluid in the
subvitreal space due to inflammation-uveal effusion or tumours.
3. Exudative retinal detachment (Coat’s disease):
Unilateral condition.
Children.
First decade of life.
More common in males than females.
It is to be differentiated from retinoblastoma, retinopathy of prematurity,
toxocara and PHPV.
76. Retinal detachment
HRSG shows a typical ‘V’ shaped echogenic membrane in the posterior
segment of eye.
This ‘V’ shape is due to insertion of the retina at optic nerve and ora
serrata.
On dynamic scanning little movement is seen due to the insertion of retina
at ora serrata at optic nerve head.
77. Tent like retinal detachment
HRSG shows typical tent like RD
caused due to the traction over
retina.
The apex of the tent is seen as the
point like attachment at the optic
nerve head and the wide base of
the tent is seen fixed at ora
serrata.
Table top retinal detachment
HRSG shows broad wide RD with
the wide base also due to the
traction RD known as the table
top detachment.
Multiple vitreo-retinal bands are
also seen.
78. Giant retinal tear
HRSG shows a thick echogenic membrane detached
from its surface from all side with folding of the
membrane s/o giant retinal tear.
There is also e/o echogenic collection seen in
subretinal space s/o subretinal hemorrhage.
79. Exudative retinal detachment
(Coats disease)
HRSG shows thick echogenic membrane detached from its
surface.
There is e/o large intra-retinal and sub-retinal exudative
collection seen responsible for detachment.
Typical findings of coats disease found in children.
It is unilateral condition.
80. Exudative retinal detachment
HRSG shows thick echogenic membranous shadows
detached from the posterior surface s/o RD.
Dense exudation is seen attached with the retina typical of
coats disease.
81. Chronic retinal tears or retinal
cysts
HRSG shows multiple renal cysts formation in the posterior
segment due to the folding of the retina in chronic long
standing tear.
82. Coiled retinal tear
HRSG shows a thick echogenic membrane detached
from its surface in a serpentine fashion s/o chronic
RD.
It shows limited movement on dynamic scanning.
Associated integral hemorrhage is also seen.
83. Giant retinal tear with retinal
cyst formation
HRSG shows total retinal detachment with folding of
retina forming the retinal cyst.
However, part of the retina is seen attached at the
optic nerve head.
84. Chronic retinal detachment
HRSG shows a thick membranous shadow with open
funnel shaped pattern. Which is seen attached at the
optic nerve s/o tractional retinal detachment.
85. Retinal buckle applications in a case
of retinal detachment
HRSG shows buckle applications at the equator in a case of
retinal detachment.
The buckles are seen in position and also keeping the retina
close to the choroid. HRSG is valuable for the evaluation of
success of post-surgical treatment of RD.
86. Slipping out of the retina under buckles
HRSG shows slipping out the retina from the buckle in a
case of failed surgical treatment of RD.
The slipped retina is seen as a ‘V’ shaped membrane and
folding of the retina is also seen at the base.
The buckles are seen in position at the equator as
echogenic bands applied at the equator.
87. Giant retinal tear with sub-retinal
hemorrhage
HRSG shows a ‘V’ shaped giant retinal tear fixed at
ora serrata and dense low level echo collection seen in
the subretinal hemorrhage.
The vitreous cavity does not show any integral
hemorrhage.
88. Proliferative vitreoretinopathy (PVR)
Thin membranes are formed on inner retinal
surface and posterior hyaloid interface.
Contraction of the membranes leads to gel
retraction, retinal traction and hemolization.
In moderate PVR, HRSG shows flappy
movements of retina.
In severe PVR funnel like retina is seen at post
equatorial retina.
A fibrous membrane is seen straching across
the anterior retina giving a classical triangle
appearance.
It is an important indication of poor surgical
prognosis.
90. Choroid
Choroid thickening may be focal or diffuse.
It is associated with many conditions. It can be due to
swelling or edema.
Causes of choroidal swelling or edema:
1. Hypotoni of ocular muscles .
2. Vascular congestion.
3. Endophthalmitis.
4. Uveitis.
5. Scleritis.
HRSG shows a highly reflective or low to medial reflective
band in choroidal thickening.
Small choroidal tumours are difficult to be differentiated
from it like choroidal melanomas, metastatic deposits or
lymphomas.
91. Choroidal detachment (CD)
Due to trauma, post-surgery or spontaneously.
HRSG shows smooth dome shaped thick
echogenic membrane in the periphery.
It shows little or no movement on dynamic
scanning.
In shallow CD it is more flat than dome shape.
Extensive choroidal detachment shows classical
kissing bullae sign on ‘B’ scanning.
Anterior choroidal detachment extends to ciliary
body and known as cilio choroidal detachment.
92. Choroidal detachment
HRSG shows a thick echogenic membrane due to
trauma in the upper temporal quadrant of left eye.
It is smooth in outline and dome shaped seen at the
periphery.
No movement is seen on dynamic scanning.
93. Post-surgical choroidal detachment
Patient complains of sudden loss of vision after the surgery for
cataract.
HRSG shows two well-defined thick echogenic dome shaped
membranes seen detached on both temporal and nasal side at the
periphery.
They are coming into the centre and giving a kissing bullae sign.
Associated integral hemorrhage is also seen.
94. Multiple choroidal detachment
HRSG shows multiple thick echogenic dome shaped
membranous shadows seen at the periphery in the
posterior pole, upper pole and nasal side of the left
eye with smooth outline s/o multifocal choroidal
detachment following trauma.
Associated integral hemorrhage is also seen.
95. Multifocal choroidal detachment
HRSG shows multiple dome shaped thick echogenic
membranous shadows coming out from all side of the
periphery to the centre in the globe.
The membranes are smooth in outline and show
limited movement s/o total choroidal detachment.
IOL is seen in position.
96.
97. Eye trauma
HRSG is a best practical method to evaluate eye
traumas, as direct vision is hampered after trauma by
opaque light conduction media.
HRSG can very well assess the extent and degree of
damage.
Early assessment of globe can result into early
surgical repair and other microsurgical procedures to
save the eye.
Sever trauma to eye can leads to sudden compression
of the eyeball anteroposteriorly and corresponding
expansion of the equatorial plane.
It may lead to rupture of globe at equator with
collapse of eyeball.
Retraction of gel with retinal tearing or dialysis can
take place.
98. Anterior segment trauma
HRSG can very well display the blood
clot and depth of anterior chamber.
Status of lens can be assessed.
Location of lens or subluxation of
lens can be detected.
99. Posterior segment trauma
Eye trauma can lead to-
• Vitreous hemorrhage.
• PVD.
• Retinal detachment.
• Retinal tears.
Dynamic scanning reveals vitreoretinal adhesions.
Longstanding post-traumatic retinal detachment may lead
to proliferative vitreoretinopathy (PVR).
Thickening of retinochoroid layer secondary to post-
traumatic edema can lead to severe visual loss when
macula is involved. It can be demonstrated on HRSG
100. Posterior scleral rupture
Sever blunt trauma can lead to posterior
scleral rupture which may be difficult to
detect clinically.
The patient usually present with normal
intraocular pressure but marked
hemorrhage, chemosis and vitreous
hemorrhage.
On HRSG, the sclera in the area of rupture
shows moderately irregular contour and low
echogenicity.
There may be indirect signs of rupture seen
on HRSG.
101. Indirect signs of scleral rupture
Vitreous incarceration into fundus with
vitreous hemorrhage and PVD.
Thickening or detachment of
surrounding retina or choroid.
Hemorrhage in the episcleral space.
Vitreous traction toward the site of
incarceration.
102. Rupture of globe
Sever blunt trauma may lead to rupture of
globe.
It usually takes place at equator.
The eye loses normal shape and loss of
ocular volume.
Associated intravitreal hemorrhage and
intraocular air also seen.
The eye gets separated from orbital wall
and shrinks.
Air may be seen in the globe if associated
with blowout fracture of ethmoid is present
with eye injury.
103. Pyophthalmos
Acute infection of eyeball results into
enlarged, swollen painful eye.
The eye size increases in acute stage.
The eyeball is filled with low-level
homogenous echoes s/o pus collection.
Ultimately eye goes into
endophthalmitis due to pyogenic
process.
104. Pyophthalmos
Dens echogenic collection
filling whole of the eye ball
and increased length of
eye.
Small collapsed same eye
after 3 months resulting
into endophthalmitis due
to panophthalmos.
105. Endophthalmitis
Due to endogenous infection present
elsewhere in in body.
Commonly occurs following surgical
trauma or penetrating injury to eye.
On B-scan imaging dens opacities are
seen in the posterior segment.
Thick echogenic exudative collection is
seen in endophthalmitis.
Diffuse thickening of retinochoroid layer
as well as tractional or exudative retinal
detachment can occur.
106. Endophthalmitis
HRSG shows small collapsed eye.
Normal anatomy is destroyed.
Dens echogenic collection is seen in the posterior segment.
Multiple calcified specks with posterior acoustic shadowing
are also seen.
Antero-posterior axis is small.
107. Expulsive hemorrhage
Most devastating complication of
intraocular surgery.
Massive subchoroidal hemorrhagic
detachment fills the vitreous cavity.
HRSG very useful in detecting
delayed expulsive hemorrhage.
In most cases, delayed hyperechoic
dots can present in subchoroidal
space.
108. Post surgical traumatic expulsive
hemorrhage
HRSG shows dens sub-cortical hemorrhage with associated
choroidal detachment after cataract surgery typical dome
shape kissing bullae sign is positive with dens integral
collection typical of subchoroidal expulsive hemorrhage.
Color doppler shows dragging of the vessels with choroidal
membrane.
109. Traumatic anterior staphyloma
A young child presented with white glistening shadow in right
eye.
HRSG shows well defined cystic mass coming out from the iris
and bulging out side.
Few internal echoes are seen in it s/o anterior staphyloma.
110. Lens material
Normal lens appears as highly reflective
concave shadow on HRSG sitting over the
vitreous gel.
Cataract lens seen as thickened biconvex
reflective body.
HRSG can very well delineate the intralenticular
constituents and also accurately measures
thickness of cataract lens.
Lens material may be lost in vitreous cavity
during surgery.
Dislocated lens may adhere to retina and does
not move on dynamic scanning unlike a
dislocated intact lens.
111. Intraocular lens
Intraocular lens creates strong artifacts,
which make the evaluation of posterior
segment difficult.
The smooth very highly reflective surface of
lens produces numerous signals producing
strong artifacts.
For proper evaluation the probe should be
kept peripheral to limbus.
112. Traumatic cataract with vitreous
hemorrhage
HRSG shows markedly thickened opaque lens.
The lens capsule is broken and prolapsed of the lens
material seen.
Associated integral hemorrhage is also seen with retraction
of vitreous.
No retinal detachment.
113. Surgical trauma to eye with IOL in
posterior segment
HRSG shows an echogenic hyper-reflective shadows
displaced in the posterior segment after post-cataract
surgery, s/o displaced intraocular lens in the posterior
segment.
Associated integral hemorrhage is also seen.
114. Blunt trauma to eye
HRSG shows subluxated thickened opaque lens in a
patient sustained blunt trauma to the eye.
Associated retinal detachment is also seen.
Integral hemorrhage is also seen.
115. Blunt trauma to eye dislocated lens in
the posterior segment
HRSG shows thickened opaque cataractous lens
displaced in the posterior segment of the eye
due to trauma.
116. Complete detachment of globe
HRSG shows complete detachment of the globe from
the orbital wall in a patient with blunt trauma to eye.
3d imaging shows details of the separation of the
globe with wall edema.
118. Eye trauma foreign bodies
Intraocular foreign bodies can easily be localised by
HRSG.
HRSG is useful for more precise location of foreign
body and to determine the extent of intraocular
damage.
Glass and stones are highly reflective masses and can
picked up easily.
HRSG is highly sensitive in picking up the track of
travelling foreign body.
FB may cause vitreous incarceration.
Air bubbles are also seen in globe associated with FB.
Air bubbles stand out as highly reflective spots, which
show rapid movements.
Associated vitreous hemorrhage, retinal tears and
scleral rupture can be well assessed on HRSG.
119. Foreign body
CT axial and coronal scan shows a hyper dense foreign
body in the orbital socket. However it is not confirmed
whether it is lying in the eye or outside the eye.
HRSG clearly shows that the foreign body is lying outside
the eyeball. It is confined to the just in the conjunctiva.
120. Foreign body in anterior chamber
X-ray of the patient shows a radio dens shadow in the orbit.
Exact location of the FB could not be determined.
HRSG of the same patient shows an echogenic hyper-
reflective shadow in the anterior chamber with posterior
acoustic shadowing.
121. Penetrating injury to eye
X-ray of the patient shows radio opaque foreign body of metallic
density lodged in the posterior segment.
HRSG of the same patient shows a hyper dens echogenic foreign
body lodged in the posterior segment with irregular shape.
It is accompanied with acoustic shadowing.
Associated dens integral hemorrhage is also seen filling the
posterior segment.
122. Organized integral hemorrhage mimicking
foreign body
HRSG shows organized integral hemorrhage in the
anterior chamber close to lens mimicking as foreign
body.
3D imaging clearly shows the organized hemorrhage
instead of foreign body.
124. Intraocular tumours
HRSG provides valuable assessment of size, shape, growth
and regression of ocular tumour.
An intraocular tumour must have a minimum thickness or
elevation (Minimum 8mm) before it can be picked up on
HRSG.
Choroidal tumours are more elevated than surrounding
retinochoroid layer in order to be detected by HRSG.
Ciliary body lesion need to be more elevated than choroidal
lesion due to irregular surface of ciliary body.
A lesion as small as 3mm can be picked up HRSG.
Other criteria includes reflectivity of lesions.
Hypoechoic lesions are easily picked up than echogenic
lesions.
HRSG can tell about base, diameter and intraocular
extension of the growth, solid and cystic nature of the
mass.
125. Tumours of anterior chamber
HRSG is an important investigation for
evaluation of tumours of anterior
chamber.
Like iris tumours, anterior ciliary body
tumours, vascular masses of sclera.
126. Cystic lesion coming out from
corneoscleral junction
A well defined mass with sharp borders seen over the left
eye encircling the pupil and hampering the vision at cornea.
HRSG shows a well defined cyst coming out from the
corneoscleral junction and also involving the iris.
Multiple thick echoes are seen in it with thick wall due to
keratinisation.
Eyeball shows normal posterior segment.
127. Iris mass : Epithelioma
HRSG shows an irregular hyperechoic mass
in the iris in a four month old child.
On color doppler study the mass shows
increased vascularity. Biopsy showed
epithelioma.
128. Medulloepithelioma (Diktyoma)
Rare tumour of ciliary body.
Seen in children.
Present as whitish mass within ciliary body.
May be associated with iris cysts or free floating
cysts within the anterior chamber or vitreous
cavity.
Tumours may be echogenic or shows moderate
echogenicity.
On color flow imaging moderate flow is seen in
them.
The teratoid variant of the tumour shows
heterogeneous echo texture due to cartilage.
129. Diktyoma
A young girl presented with white eye reflex and a mass in
anterior chamber on clinical examination.
HRSG shows a well defined homogeneous mass coming out
from the ciliary body and confined to the anterior chamber.
The sonographic findings are s/o diktyoma or
medulloepithelioma.
130. Diktyoma
A young girl presented with white eye reflex and diminished vision
on clinical examination.
HRSG shows a well defined echogenic mass coming out from the
ciliary body and extending into vitreous cavity.
No cystic degeneration seen in the mass.
On biopsy- diktyoma.
131. Medial Canthus Cysticercosis
A young girl presented with cystic mass over the medial
canthus.
HRSG shows a well defined cyst having an echogenic nidus
fixed with inner wall of the cyst typical of cysticercus cyst.
Color doppler imaging shows no flow in the cyst.
132. Lateral Canthus Cysticercosis
A young child presented with left lateral canthus swelling.
HRSG shows a well defined cystic mass coming out from
the lateral canthus.
An echogenic nidus is seen fixed with the inner wall of the
cyst typical of cysticercus cyst.
Color doppler imaging shows cyst wall hyperemia.
133. Cavernous Hemangioma
A young man presented with mass having multiple dilated
vessels in upper part of right eye.
HRSG shows a soft tissue mass with multiple dilated
vessels.
Echogenic calcified shadows are also seen in the mass.
They are associated with acoustic shadowing s/o phlebolith.
134. Cavernous hemangioma
On color doppler flow study, low flow is seen in the blood vessels
with venous flow pattern.
Color doppler tracing shows venous and arterial flow pattern in
the mass.
On persistent bending of head, vessels show engorgement and
increase in size.
Color doppler shows vessel engorgement
135. Retinoblastoma
Most common intraocular tumour in infant
and children upto the age of 6 year.
30% of all ocular tumours.
Unilateral, bilateral, focal or multifocal.
Present as white reflex or cat eye reflex in
the children.
The tumour can grow either anteriorly from
inner surface of the retina towards the
vitreous(endophytic), or posteriorly form
the posterior surface of retina towards the
choroid( exophytic).
136. Retinoblastoma
Sonographic features:
• Smooth dome shaped appearance when it is
small in size.
• Heterogeneous and irregular structure.
• Calcium deposits are hallmark of
retinoblastoma.
• Usually comes out from one surface of retina.
In unusual case it involves entire surface of
retina. Known as retinoblastoma
circumference.
• Tumour usually grows anteriorly and fills
vitreous cavity. It can invade the choroid and
grows posteriorly in the retrobulbar space.
137. • HRSG can clearly assess the retrobulbar
extension of tumour growth and its excavation
in the choroid.
• HRSG is also useful and noninvasive tool to
monitor the treatment response of the tumour
or to assess regression of tumour growth.
• The tumour is radiosensitive, and rapid
regression takes place after radiotherapy and
chemotherapy.
138. Differential diagnosis
Coats disease or exudative retinal
detachment.
Persistent hyperplastic primary
vitreous (PHPV).
Retrolental fibroplasia.
Toxocara worm infestation: Ocular
endophthalmitis or a posterior
granuloma.
139. Lobulated retinoblastoma
A young child presented with leukoria in
both eyes with loss of vision in right eye.
140. Bilateral retinoblastoma
A young child presented with bilateral cat eye reflex. It was more
marked on left side.
HRSG shows a small echogenic shadow fixed with the posterior
pole of the eye with echogenic calcification s/o retinoblastoma.
HRSG shows big tumor mass in left eye.
It is irregular in out line. Dens calcification seen in the mass.
However it is confined to the retina. No choroidal excavation is
seen.
141. Retrobulbar extension of retinoblastoma
Big retinoblastoma is seen invading the sclera and
also extending in retrobulbar space.
The tumor has caused pressure over optic nerve.
142. Ocular melanoma
Most common tumors in adults.
Comprises about 40% of tumors.
85% arise from choroid and remaining 15%
arise from ciliary body.
Most commonly occur in fifth and sixth
decades of life and rarely before third
decade and after eighth decade of life.
Most common in white skinned people and
rare in blacks.
HRSG is highly sensitive in evaluating the
size, shape, growth and extent of tumor.
143. Ocular melanoma
Sonographic features:
• Typically dome shaped.
• Collar button appearance with smooth surface.
• They have low reflectivity with medium
echoes.
• Homogenous.
144. Disciform melanoma
HRSG shows well defined discoid mass over the posterior
pole.
Homogenous in texture.
Associated retinal detachment is also seen.
Color doppler shows moderate flow in the tumor.
145. Small collar button melanoma
A well defined homogenous soft tissue mass seen coming
out from choroid.
On color flow imaging a big vessel is seen feeding the
tumor.
146. Collar button melanoma
Well defined homogenous melanoma with wide base.
The tumour is having smooth outline and confined to the choroid
layer.
No extrachoroidal extension is seen.
Color doppler study shows high vascularity of the tumour with
multiple feeding vessels.
Associated retinal detachment is also seen.
147. Discoid melanoma
HRSG shows a choroidal melanoma with smooth
elevation and wide base.
No e/o any necrosis is seen in it.
Multiple vessels are seen feeding the tumor.
149. Posterior scleritis
HRSG shows thickening of the sclera with e/o edematous
hypoechoic sclera.
The inflammatory fluid is seen seeping along the tenons space
and also in the optic nerve sheath.
Typical positive ‘T’ sign in posterior scleritis.
Color doppler imaging shows increased blood flow in the sclera
due to hyperemia.
152. Orbital anatomy
Bony socket.
Contains:
• Eyeball
• Extrinsic muscles.
• Optic nerve embedded in fat.
• Vessels and nerves innervating the eyeball.
Eyeballs not lying along the axis of orbit. They face
forward and lie parallel to each other.
Optic nerve is echo poor in texture lying freely in the
retro orbital fat, which is highly echogenic.
Intraorbital part of optic nerve is around 25mm.
HRSG can show the whole length of optic nerve in the
orbit with careful examination.
It can be seen longitudinally and transversely as oval
hypoechoic shadow.
153. The four recti muscles arise from tendinous ring at the apex
broaden out to form a cone of muscles around the eyeball.
The orbital muscles are seen as thin, echo poor straps.
Tendons are narrowed anteriorly and muscle belly is more
fusiform in shape.
The medial and lateral recti are seen in horizontal planes
and superior and inferior recti are seen in vertical planes.
The inferior oblique muscle is seen behind the globe just
below the macula.
The superior oblique is seen in superomedial part of the
orbit.
154. Examination technique
Short focus high frequency transducers with
frequency ranging from 5MHz to 10MHz are the
ideal probes to examine orbits.
Direct contact method is the ideal technique.
Examination is carried out in both transocular
and paraocular approaches.
The orbit is examined in transverse, axial and
longitudinal views.
The orbit is examined in all four directions:
superior, inferior, medial(nasal) and
lateral(temporal).
155. Proptosis
1. Muscle hypertrophy in thyroid
disease.
2. Pseudotumors- inflammatory
orbital disease.
3. Vascular tumors.
1. Hemangioma.
2. AV malformations.
3. Orbital varix.
4. Lymphangioma.
5. Dilated superior ophthalmic vein.
4. Parasitic infestations.
1. Cysticercosis.
2. Hydatid cysts.
5. Optic nerve tumors- glioma.
1. Meningioma.
2. Optic nerve cyst.
3. Optic nerve glioma.
6. Rhabdomyosarcoma.
7. Lymphoproliferative masses.
8. Lymphoma.
9. Metastatic deposits in the orbit.
10.Orbital trauma/ Orbital hematoma.
Anterior displacement of eyeball due to retrobulbar pathology can easily
be evaluated on HRSG.
The retrobulbar masses which can be detected well on HRSG are
grouped as under.
157. Vascular tumors of the orbit
Many vascular tumors found in the orbit.
It is one of the most common causes of
proptosis.
HRSG is excellent modality to diagnose vascular
tumors.
Color doppler flow study can easily differentiate
between venous or arterial nature of the tumor
mass.
158. Hemangiomas
Benign.
Adults: Second to fifth decade of life.
Progressive swelling of eyeball with unilateral proptosis.
HRSG shows highly reflective echogenic mass in retro
orbital space, which is seen located in muscle cone.
The multiple interphases of dilated capillary walls produce
an echogenic mass.
Doppler examination gives a good account of blood flow in
the mass.
159. Cavernous hemangioma
A young lady came with the history of proptosis in right eye with
blurring of vision.
HRSG shows a low level echo complex mass in intraconal part of
right orbit.
Multiple fine thin interphases are seen in the mass.
The mass is seen pressing over the optic nerve and displacing it to
the opposite side. A smooth indentation is seen over the nerve.
No e/o any calcification is seen in the mass.
160. Cavernous hemangioma
Color doppler shows multiple dilated vessels seen in
the mass with high flow pattern.
Spectral doppler flow shows high flow with arterial
pulsation in the mass s/o cavernous hemangioma.
161. Arteriovenous fistulae
Post-traumatic or spontaneous.
They are often missed clinically.
Therefore HRSG is useful investigation to
diagnose them.
Doppler examination is helpful in diagnosing
small fistulae.
162. Orbital varices
They are usually diagnosed clinically.
They often increase in size with bending of head
or valsalva maneuver.
These patients ultimately land up in
endophthalmitis most likely due to fat necrosis.
163. Orbital varix
Multiple dilated vessels are seen in retrobulbar
area s/o orbital varix.
On color doppler flow, low venous flow is seen
in them.
164. Lymphangioma
Children and young adults.
Grow slowly and causing proptosis.
May present as acute onset due to spontaneous
secondary hemorrhage.
Can be small or large enough to fill orbital space.
On HRSG, multiple dilated septate lymph filled spaces
seen in retrobulbar areas.
A multiloculated mass is seen with echogenic septa.
If hemorrhage is present in tumor, low to medium
level echoes are seen in the dilated spaces.
Decompression of lymphangioma at times is
necessary and ‘B’ scan imaging is used to guide the
aspiration needle.
165. Lymphangioma
Cystic mass with thick echogenic septa is seen filling the
retrobulbar space.
Poor flow is seen in the mass on color flow.
Biopsy proved lymphangioma.
166. Muscle hypertrophy
Associated with (Grave’s disease).
3-5% of cases hypertrophied muscles compress the optic
nerve resulting into severe threat to vision.
HRSG is good non-invasive method to evaluate hypertrophy
of muscles.
Medial rectus is taken as standard and thickness of more
than 4mm is taken as hypertrophy of muscles.
Typically the muscle enlargement takes place in muscle
belly.
Other features- increased orbital fat and orbital edema.
The edema appear as echo poor areas in orbital fat.
167. Muscle hypertrophy of thyrotoxicosis
A patient presented with bilateral orbital proptosis.
HRSG shows marked thickening of the recti muscles in the oebit.
The lateral and medial recti muscles are 7 and 6mm in thickness
(normal<3mm). Increased amount of orbital fat is also seen
typical feature of thyrotoxicosis.
Left eye also shows thickened recti muscles. They are 7 and 6mm
in thickness (normal<3mm)
168. Dilated superior ophthalmic vein
A patient presented with proptosis and optic disc edema.
HRSG shows dilated superior ophthalmic vein congested in the
intraconal part.
Color doppler flow imaging shows monophasic venous flow in the
vein.
169. Dilated superior ophthalmic vein
Spectral doppler confirms the venous flow
pattern of dilated superior ophthalmic vein.
CT scan of the same patient shows tortuous
dilated superior ophthalmic vein.
170. Inflammatory orbital disease
(Pseudotumor)
Group of nonmalignant orbital tumors which involve
orbital muscles.
• Myositis.
• Periscleritis.
• Perineuritis.
• Pseudotumors.
It results in proptosis diplopia and at times painful
eye.
Unilateral.
Idiopathic.
On HRSG thickening of the muscle belly is seen. It is
echo poor with nodular in appearance.
Difficult to differentiate from malignant mass.
Pseudotumors respond well to steroid therapy.
171. Pseudotumor orbit
Patient presented with unilateral proptosis with diplopia.
Well defined homogenous lobulated mass in lateral rectus
muscle.
The mass regressed in size on corticosteroid therapy.
172. Myositis of lateral rectus muscle
HRSG shows localized thickening of lateral rectus
muscle in a patient presented with proptosis.
173. Myositis of superior rectus muscle
HRSG shows marked thickening of superior rectus muscle
in a patient presented with proptosis.
Color doppler imaging shows increased flow in thickened
muscle.
174. Primary tumors of orbit
RHABDOMYOSARCOMA:
Most common tumor in childhood.
Presents as rapidly increasing exophthalmos.
Highly cellular and involves any part of orbit.
It arises from extra ocular muscles.
Commonly seen in super nasal quadrant of orbit.
HRSG shows well circumscribed and medium to low
echo complex mass.
Connective tissue septa can be seen in tumors at
times.
In small tumors the orbital wall remains intact,
however, in big tumors they may be eroded.
Pseudotumors and lymphomas are the differential
diagnosis of rhabdomyosarcomas.
175. Rhabdomyosarcoma
Contrast enhanced axial CT image through
orbits demonstrates right proptosis due to
large, lobular, intraorbital mass.
Also there is invasion of right maxillary sinus as
well as extension through lateral orbital wall.
176. Lymphoproliferative masses
ORBITAL LYMPHOMA:
Usually of Non-Hodgkins type.
HRSG shows a mixed echo complex
mass in the retrobulbar space.
Elongated or oval mass.
Shows good acoustic transmission.
Usually bilateral, may be unilateral,
focal or multi-focal in position.
HRSG can not demonstrate between
inflammatory or malignant lymphomas.
177. Orbital metastasis
Common in 40% cases of neuroblastoma.
Also seen in osteocarcinoma, Ewing's
tumor and in rare cases of
adenocarcinoma.
Hypoechoic nodular mass with
heterogeneous texture.
Infiltrating metastases can destroy the
bony walls or orbit.
178. Metastatic deposits from neuroblastoma
A young boy presented with left proptosis with swelling of
the left jaw.
HRSG- highly vascular soft tissue mass in left orbit.
Metastatic deposit from tumor.
Highly vascular mass invading left maxilla and eaten up the
bone the bone metastatic deposit.
179. Metastatic deposit- Adenocarcinoma
Patient presented with swelling over lateral side of left
orbit.
HRSG showed irregular nodular mass in lateral quadrant of
orbit displacing the eyeball.
Open biopsy- metastatic deposit from adenocarcinoma.
180. Optic nerve tumors
Meningioma:
Optic nerve sheath tumors.
Present as slowly developing proptosis and
unilateral in origin.
Vision impairment is associated with the
tumor when it enlarges and ruptures
through the dura matter.
Occupies retrobulbar space.
Highly reflective masses..
Calcification may present in optic nerve
sheath or in tumor.
181. Optic nerve meningioma
A women presented with proptosis and diminished vision.
HRSG shows well-defined fusiform soft tissue mass coming
out from the optic nerve.
Echogenic calcification is seen in it.
Biopsy shows optic nerve meningioma.
182. Optic nerve glioma
Optic nerve glioma are smooth,
fusiform or ovoid mass which replace
the normal optic nerve.
The lesion is poorly reflective and
shows poor acoustic transmission.
Ct is better investigation for
diagnosis of optic nerve glioma.
183. Optic nerve glioma
A young lady presented with loss of vision with
proptosis right eye.
HRSG shows fusiform widening of optic nerve with
echogenic mass in the nerve s/o optic nerve tumor.
184. MRI of the same patient shows fusiform mass coming
out from the optic nerve with expansion of apex of
cone. Biopsy showed optic nerve glioma
185. Neurilemmoma
Rare.
Arise from proliferation of Schwann
cells.
Hypoechoic nodular masses and
seen in the superior orbit.
They may present in muscle cone in
extraocular compartment.
186. Optic neuritis
Optic nerve is enlarged due to fluid collection in perineural
sheath.
Optic nerve gets thickened.
The 30 degree test is valuable test to differentiate between
optic nerve tumor or inflammation.
The test is carried out in fixed primary gaze position, and
the patient is asked to rotate his eye to 30 degree towards
the probe.
In case of fluid collection, the fluid redistributes itself along
the optic nerve sheath as the nerve stretches and the
swelling subsides.
However the swelling persists on rotation of eye to 30
degree in case of tumor of optic nerve.
187. Optic neuritis
Straightening and thickening of right optic nerve. Similar but less
sever changes on left eye.
Axial post contrast MR image with fat saturation demonstrates
enhancement of the intraconal portion of the right optic nerve.
Normal left optic nerve is indistinguishable from the surrounding
intraconal fat.
188. Parasitic infestation
ORBITAL CYSTICERCOSIS:
Most common extra cranial manifestation of
cysticercus infestation.
The disease mainly affects extraocular muscles and
mainly the recti.
Presents as painful slowly progressing proptosis.
HRSG:
A well-defined cystic mass seen in the belly of muscle.
A highly echogenic nidus is seen within the cyst.
It is the scolex of parasite.
This scolex is echo dens and present near the inner
wall of the cyst.
The muscle belly shows localized thickening which can
be well appreciated on HRSG.
189. Bilateral Cysticercosis
HRSG shows thick walled cysts in both side lateral recti with
scolex fixed with inner wall of cyst as echogenic nidus.
CT head of the same patient shows multiple hyper dens dot
shadows, diffuse in distribution in widespread
neurocysticercosis.
190. Lateral rectus Cysticercosis
Well defined cyst in lateral rectus with a hyper dens
echogenic nidus fixed with inner wall of the cyst.
CT head of the same patient shows gross impregnation of
brain parenchyma with neurocysticercosis.
191. Hydatid cyst
Orbital Hydatid cyst are not very
common.
Present in retrobulbar area as a well
defined thin walled cystic mass.
It stands out very clearly on HRSG.
Sometimes septa are present in cyst
making loculations and septations.
The eye is displaced to opposite side by
the pressure effect of the cyst, and
associated proptosis is also present.
192. Retrobulbar hydatid cyst
A young boy presented with left eye proptosis.
HRSG shows a thick walled cyst in retrobulbar space.
Cyst wall also shows calcification, typical finding of hydatid
cyst.
No daughter cyst is seen.
193. Posterior staphyloma
Both eyeballs are oblong in shape with increased axial
length.
Right eye is 30mm and left eye is 30.4mm.
Presented as bilateral proptosis.
194. Retrobulbar hematoma
A young boy sustained blunt injury to eye and presented
with proptosis with painful eye.
HRSG shows low level echo complex mass in retrobulbar
space with anterior displacement of eyeball.
Few internal echoes are seen in it s/o retrobulbar
hematoma.
Eye was normal.
Patient was responded to compression bandage.
195. Retrobulbar abscess
A young boy presented with proptosis with
painful eye and chymosis.
HRSG shows a low level echo complex mass
in retrobulbar area layering of fluid is seen
indicating a retrobulbar abscess.
196. Retrobulbar cystic dermoid
A young girl presented with right sided proptosis.
HRSG shows a thick walled cystic mass in the
retrobulbar space.
Echogenic calcification is seen in it.
CT scan of the same patient shows well defined cyst
in the retrobulbar intraconal space.
Biopsy of the cyst was dermoid cyst.
197. Periorbital masses
LACRYMAL DUCT CYSTS (DACRYOPS):
HRSG shows multiple small cysts in upper eyelid
involving palpebral part of lacrimal duct.
Tiny echogenic calcified specks are also seen in
them s/o ductal ectasia of lacrimal duct also
known as dacryops.
It is a rare condition of lacrimal duct caused due
to obstruction and ectasia of lacrimal gland duct.
198. Carcinoma of lid
Malignant tumor.
Highly heterogeneous in texture.
Rapidly growing tumor.
Tumor can invade the eyeball and infiltrate the
sclera which can be very well appreciated on
HRSG.
The tumor is seen invading the conjunctiva,
sclera and muscle coat of eyeball, and the lid is
firmly attached and it is not retractable.
199. Mucocele invading the right orbit
A lady patient presented with swelling over the medial side
of the eye with lateral displacement.
HRSG shows a thick echo complex mass coming out from
the nasal cavity and pressing over the right orbit displacing
the eyeball down.
Thick echoes are s/o mucocele.
200. Mucocele invading the right orbit
CT of the same patient shows a hypo dens
mass seen coming out from the right nasal
cavity eroding the medial wall of the orbit and
invading the retrobulbar space.
201. Conclusion
HRSG is a non invasive multiplanner , widely available
imaging modality for evaluation of eye and orbit.
The tissue characterization of mass is better than CT.
It is the only practical method of examining the eye, when
light conducting media are opaque.
For orbit, CT is better technique as it provides the global
view.
But HRSG is better to differentiate between solid and cystic
masses.
The limitation of HRSG is limited field of view and extra
orbital extension of the disease in the cranium, where CT is
definitely superior than USG.
The biggest advantage of Ultrasonography over CT is its
wide availability, rapidity of investigation and cost
effectiveness.
Therefore, it is the first line of investigation in orbital
proptosis.
