Current-practice safety note: Before considering ocular ultrasound after trauma, assess for an open-globe injury. If an open-globe injury is suspected, avoid pressure on the eye and do not perform bedside ocular ultrasound; obtain immediate ophthalmology assessment. Severe traumatic hyphema also warrants urgent ophthalmic assessment. Sources: ACEP Sonoguide; AAO EyeWiki: ophthalmic triage.
The original case report describes severe #hyphema following cricket-related eye trauma. A gentle ocular #ultrasound using a linear probe, performed with minimal pressure to prevent further injury, was reported to reveal a #retinal tear.
The case account does not include visual acuity, globe-integrity assessment, dilated retinal examination findings, treatment or follow-up. Ophthalmology confirmation of the reported tear is not described.
First decide whether scanning is safe
Record visual acuity in each eye and assess pupils without pressing on the injured globe. A penetrating mechanism, visible wound or prolapsed tissue, peaked pupil, or abnormal anterior-chamber depth raises concern for an open globe. Stop pressure-producing examination, avoid tonometry and bedside ultrasound, place a rigid eye shield without a pressure patch, and obtain immediate ophthalmology input. These precautions apply even when the injury initially appears to be blunt. AAO EyeWiki: penetrating and perforating injuries.
What the ultrasound can answer
Once an open globe is not suspected, ocular POCUS can help assess the posterior segment when hyphema obscures the view. Use a high-frequency linear probe, generous gel over the closed lid and no globe pressure. Sweep through the eye in two planes; assess membrane attachment and mobility rather than interpreting one still image. Inadequate views are indeterminate. ACEP Sonoguide.
A retinal detachment may appear as an echogenic membrane tethered at the optic disc. Posterior vitreous detachment is usually thinner and more mobile, without the same disc attachment. Vitreous hemorrhage may produce moving low-level echoes or organized membranes that mimic detachment. These findings can coexist; seeing vitreous pathology does not exclude an associated retinal break. ACEP Sonoguide.
A retinal tear is a break in the retina; retinal detachment is separation of the retina from the underlying tissue. They are related but different diagnoses. A small peripheral tear may be missed on ED POCUS. Do not use a negative scan to exclude a tear or to cancel ophthalmic examination. AAO retinal-breaks Preferred Practice Pattern.
In a prospective study of 225 ED patients, POCUS sensitivity for retinal detachment was 96.9% and specificity 88.1%. Ocular trauma and suspected globe rupture were excluded, and retinal tears were not a diagnostic endpoint. Those results therefore cannot validate tear detection in this cricket injury. Lahham et al., JAMA Network Open, 2019.
The disposition matters more than the scan
Severe traumatic hyphema warrants urgent ophthalmic assessment. Reduced vision, a new field defect or curtain, flashes or new floaters strengthen concern for posterior-segment injury. Arrange urgent ophthalmology assessment and a dilated peripheral retinal examination when safe; an obscured view may require specialist B-scan and repeat examination. Do not delay referral to obtain better POCUS images. Before discharge, confirm the specialist plan and explain that worsening vision, new flashes, floaters or a curtain require immediate reassessment. AAO EyeWiki: ophthalmic triage; AAO retinal-breaks guidance.
Acoustic-output safety: Use equipment and a preset approved for ophthalmic scanning, follow the manufacturer’s instructions, and apply ALARA. FDA ophthalmic guidance specifies a maximum mechanical index of 0.23; a low displayed thermal index alone does not establish appropriate ocular output. FDA ultrasound-system guidance; AIUM ophthalmic training safety.
