Ultrasound of the eye: retina, vitreous body, tumors

An ultrasound examination of the eye is most often prescribed when the posterior segment of the eye cannot be properly examined due to clouding of the optical media. A typical example is a dense cataract or vitreous hemorrhage, when ophthalmoscopy and some optical methods become uninformative. [1]

In practical diagnostics, ultrasound solves three major problems: confirming or ruling out retinal detachment, understanding the nature of changes in the vitreous, and identifying and measuring intraocular or orbital lesions. This helps quickly determine the urgency of referral to a specialist and select further imaging. [2]

The method is valuable because it provides real-time images and allows for dynamic testing: asking the subject to shift their gaze, assessing the mobility of membranes and vitreous suspension, and observing the "after-movement" of structures. It is precisely mobility and the location of fixation that often become key to distinguishing diagnoses. [3]

It's important to understand the limitations: ultrasound is not a substitute for a full fundus examination in clear media and should not be considered a "definitive diagnosis" in complex cases. Even with a good image, false-positive and false-negative results are possible, especially in traumatic scenarios and when searching for retinal tears. [4]

Table 1. When is an ultrasound examination of the eye most useful?

Clinical situation	The main goal	What can usually be assessed
Dense cataract, opaque media	"Seeing" the posterior segment through the clouding	Retinal detachment, intraocular masses, vitreous changes
Suspected retinal detachment	Confirmation and estimated prevalence	Membrane, fixation site, mobility, possible funnel-shaped configuration
Vitreous hemorrhage	Distinguish between blood suspension and membranes and assess the risk of associated pathology	Suspension, clots, traction, concomitant detachment
Suspected choroidal tumor	Detect, measure, describe shape	Thickness, base, contours, signs of exudative detachment
Inability to quickly obtain another visualization	Quick sorting by urgency	Signs requiring urgent consultation

This table summarizes the most consistent indications: work through opaque media, assessment of retinal and vitreous detachment, and measurement of tumor formations, which are covered in detail in reviews of ophthalmologic ultrasound and in materials on ultrasound diagnostics of uveal melanoma. [5]

Safety and preparation: what's important before the test

Preparation is usually simple: contact lenses are removed, and eye makeup should be removed to prevent the sensor from slipping and contaminating the gel. The examination is often performed through a closed eyelid using a gel, which reduces the risk of discomfort and avoids direct contact with the cornea.

A key principle of ocular safety is acoustic power control. For ophthalmological examinations, the mechanical index should not exceed 0.23, and the operator is required to use the minimum required power and scanning time settings. [6]

Doppler modes are a separate issue. They potentially use higher acoustic exposure, so when assessing ocular blood flow, it is especially important to monitor the safety indices on the device's screen and not "hold the beam" longer than necessary to obtain a measurement. [7]

There are situations where the examination is performed only for strict indications and with the utmost care, or is temporarily postponed: suspected penetrating injury and possible rupture of the eyeball. In a large diagnostic ultrasound study in the emergency room, patients with suspected rupture of the eyeball were excluded, reflecting the generally cautious approach. [8]

Table 2. Limitations and precautions for ultrasound examination of the eye

Situation	Why is it important?	How do they usually do it?
Suspected rupture of the eyeball	Risk of increasing damage by putting pressure on the eye	Urgent ophthalmologic evaluation, pressure avoidance, imaging as determined by the specialist
Recent eye surgery	Increased tissue sensitivity may occur.	Individual solution, gentle technique
Severe pain when touching the eyelid	Difficult to perform without pressure and artifacts	Anesthesia as indicated, reduction of scanning time
The need for Doppler assessment	Higher exposure is possible	Mechanical index and time control, minimal settings

The point of this table is that safety is determined not only by “can or can’t”, but also by technique: minimum pressure, choice of ophthalmological preset and control of the mechanical index. [9]

How the study is performed: modes, frequencies, planes, what should be in the protocol

The classic modes are A-scan and B-scan. A-scan displays the signal as peaks, which is convenient for biometrics and assessing tissue reflectivity, while B-scan produces a two-dimensional image and is the basis for diagnosing retinal pathology, vitreous body pathology, and tumors. [10]

According to reference materials, frequencies for basic ophthalmic ultrasound are typically around 8 MHz for A-scans and 10 MHz for B-scans. Higher frequencies improve detail but decrease penetration depth, so the choice of mode and transducer always balances between "seeing deeper" and "seeing sharper." [11]

Ultrasound biomicroscopy is used for the anterior segment: this is a high-frequency method, with reviews citing a range of 50-100 MHz, allowing for very high resolution of the anterior chamber and ciliary body structures. In the context of tumors, this is important when ciliary body damage is suspected, when standard ophthalmologic ultrasound may not be sufficiently "subtle." [12]

A high-quality posterior segment protocol typically includes scanning in at least two mutually perpendicular planes, a description of membrane mobility during eye movement, fixations at the optic disc, and measurements if a mass is detected. For tumors, the base size and maximum thickness are critical, as these parameters are used for monitoring and treatment planning. [13]

Table 3. Modes and their practical role

Mode	What does it give?	Where it is especially useful
In scanning	Two-dimensional image of the eye structures	Retinal detachment, vitreous changes, tumors
And scanning	Reflectance peaks and internal reflectivity assessment	Biometry, clarification of tumor characteristics
Color Doppler ultrasonography	Assessment of the direction and velocity of blood flow	Vascular tasks, part of oncological and ischemic scenarios
Ultrasound biomicroscopy	High resolution front segment	Pathology of the anterior chamber and ciliary body, anterior tumors

This table reflects the modern division of labor: B scanning is responsible for the “picture”, A scanning adds reflection characteristics, and Doppler techniques are applied selectively for vascular issues, with mandatory control of safety parameters. [14]

Retina and vitreous: What key findings look like and how to differentiate them

On ultrasound, retinal detachment typically appears as a bright membrane associated with the optic disc and may form a funnel-shaped configuration in cases of total detachment. Mobility is often present, but it may be limited in tractional cases, so dynamic real-time assessment is important. [15]

Posterior vitreous detachment often manifests as a thinner, less bright membrane with pronounced "aftermovement" during eye movements. The practical difficulty is that some cases of posterior vitreous detachment can mimic retinal detachment, so it is necessary to examine the site of attachment and the overall geometry of the membrane. [16]

Vitreous hemorrhage typically appears as an echogenic suspension of varying density, sometimes with clots, and with eye movements, the suspension can "mix" and change configuration. This is where ultrasound is particularly valuable, as the hemorrhage often obscures the view of the fundus, and the goal is to detect any accompanying retinal detachment. [17]

Diagnostic accuracy depends on the conditions and the task. In a large multicenter study of ultrasound in the emergency room, sensitivity for retinal detachment was high, but for posterior vitreous detachment it was significantly lower, indicating that these subtle differences require experience and careful interpretation. [18]

If the context is traumatic or there is severe eye injury, the picture becomes more complex: according to a study after open eyeball trauma, ultrasound was effective in detecting vitreous hemorrhage, but significant false positives were observed for other types of vitreoretinal pathology. This means that in trauma cases, conclusions should be especially tied to the clinical presentation and treatment plan, not just the imaging. [19]

Table 4. The most common pictures in pathology of the retina and vitreous body

Find	Typical ultrasound appearance	A hint for distinction
Retinal detachment	Thick, bright membrane, connection with the optic disc	Often fixed at the disk, can form a "funnel"
Posterior vitreous detachment	Thin membrane, noticeable after-movement	Less pronounced fixation, higher “buoyancy”
Vitreous hemorrhage	Echogenic suspension, clots, heterogeneity	Changes shape with eye movement, making fundus view often impossible
Combination of hemorrhage and detachment	Suspension plus separate membrane	An assessment of membrane fixation and geometry is required.

The point of the table is not “self-diagnosis,” but what signs the doctor usually describes in the conclusion and why one sign without dynamics may be insufficient. [20]

Tumors and pseudotumoral conditions: what ultrasound reveals and which signs are most important

When an intraocular tumor is suspected, ultrasound remains a key method because it allows for visualization of the tumor even in opaque media, assessment of shape and contours, and measurement of size. For uveal melanoma, reviews emphasize the central role of B-scanning and A-scanning, as well as the importance of thickness and baseline measurements for monitoring and treatment. [21]

According to reviews, typical uveal melanoma often has a dome-shaped form, sometimes "mushroom-shaped," and on A-scan may be characterized by moderately low internal reflectivity. Importantly, exudative retinal detachment or subretinal fluid is often found nearby, so the description should also include "adjacent" changes. [22]

A separate area is tumors of the anterior segment and ciliary body. Here, standard ophthalmologic ultrasound may not provide sufficient detail, and high-frequency ultrasound biomicroscopy is then used, which provides a more precise profile and size of the lesion within a shallow depth. [23]

Pseudotumoral conditions are important because they can mimic a "mass" on B-scans: organized hemorrhage, prominent membranes, inflammatory thickenings. Therefore, a competent diagnosis typically considers the shape, internal structure, and dynamics and, if necessary, is supplemented by other imaging techniques and dynamic observation. [24]

Table 5. What is usually recorded in the description when a tumor is suspected

Parameter	What is being measured or described?	Why is this important?
Form	Flat, dome-shaped, "mushroom-shaped"	Helps in differential diagnosis
Dimensions	Base and maximum thickness	Basis for monitoring and treatment planning
Internal reflectivity	Evaluation of structure in A-scan	Additional fabric type indicator
Related changes	Subretinal fluid, exudative detachment	Affects symptoms and tactics
Signs of spread	Suspected of extending beyond the eyeball	May change treatment strategy

This table is based on how reviews of uveal melanoma describe the minimum required elements of an ultrasound report: size, shape, and characteristics that influence treatment and follow-up decisions.[25]

Doppler techniques: when they are used and what the results mean

Doppler techniques are used selectively in ophthalmology: to assess blood flow in the ophthalmic artery and its branches, as well as in certain vascular and inflammatory conditions. Research and clinical guidelines emphasize that Doppler assessment complements the structural picture, but rarely exists "in isolation" without a clinical context.

In practical indications, ischemic scenarios and occlusions are most often discussed: spasm or occlusion of the central retinal artery, central retinal vein thrombosis, as well as hemodynamic changes associated with significant stenosis of the internal carotid artery. These are the examples listed in specialized guidelines on Doppler ultrasonography of the eye.

Safety is particularly sensitive here: ophthalmological recommendations emphasize monitoring the mechanical index and thermal index, as ocular tissue is vulnerable to the biological effects of ultrasound. The practical conclusion is simple: use ophthalmological device settings and limit the Doppler beam "hold" time. [26]

Interpretation of Doppler parameters requires caution: the "normal" depends on the technique, insonation angle, settings, and individual anatomical factors. Therefore, in a typical clinical workup, Doppler data are considered in conjunction with an ophthalmological examination and a general vascular assessment, rather than as a standalone diagnosis. [27]

Table 6. Understanding the results: what usually requires accelerated tactics

Ultrasound finding	Why is this important?	What do they usually do next?
Signs of retinal detachment	Risk of irreversible vision loss	Urgent ophthalmologist consultation, treatment plan
Vitreous hemorrhage without fundus view	Retinal detachment may be hidden	Clarifying examination, dynamics, surgical tactics if necessary
A formation suspicious for a tumor	Size and signs of activity are important	Ophthalmic oncologist, measurements, complementary imaging
Unstable picture in trauma	Risk of misinterpretation	Management in a specialized center, comparison with a clinic
Doppler signs of severe ischemia	Possible vascular accident	Urgent clinical route due to

The logic of the table is consistent with the diagnostic accuracy data: ultrasound is particularly useful for rapid triage by urgency, but final management should be based on clinical assessment and profile confirmation.[28]