Ever feel frustrated with your eye exam? Confused by the slit lamp and even more distressed at the thought of doing fundoscopy? Point-of-care ultrasound (POCUS) is taking over emergency medicine and improving your eye exam is another area where it can help. Actually the eye is an ideal structure for viewing with ultrasound since it is a superficial structure and conveniently fluid filled. However, the spherical three-dimensional structure of the ocular globe can lead you astray when trying to view it using a two-dimensional ultrasound image. This POCUS post offers an introduction to scanning the eye and some tips to make sure you capture the full 3D details.
Case:
A 66 year-old man presented with 2 weeks of increasing cough, generalized weakness, and decreased oral intake. He has a past medical history of a tonsillar squamous cell carcinoma for which he had received both chemo and radiation therapy. His last treatment was months prior. He was followed by the palliative care service who was managing his throat pain with hydromorphone.
He reported an increasing non-productive cough without fever, nausea, vomiting, or other systemic symptoms. He endorsed severe weakness without any focal neurologic deficit. He denied chest pain and pleuritic chest pain. He was mildly short of breath without orthopnea or paroxysmal nocturnal dyspnea.
He presented with abnormal vital signs: Temp 37.7C, HR 124, RR 18, 118/54, 84% on room air. He was a cachectic man with dry mucous membranes. There was no increased work of breathing. Neurologic, Cardiac, resp, and abdominal exams were normal. There was no unilateral calf swelling or tenderness.
A 66 year-old woman presented to the emergency department complaining of a headache for the past 6 weeks. She described it as a throbbing pain in the frontal region and behind her eyes. She had no neurologic complaints, no vision changes, no scalp pain or jaw claudication.
Her past history was significant for hyperparathyroidism, migraines, GERD, and factor XI deficiency.
Her medications included a triptan and a PPI
Her vital signs were normal except for an elevated BP of 180/112. Her examination including a full neurologic exam was unremarkable. Her fundi were difficult to visualize clearly, therefore we proceeded with an ocular point-of-care ultrasound.