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Sonography of the Eye

¹ Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Box 57, 1515 Holcombe Blvd., Houston, TX 77030.
² Department of Ophthalmology (Plastic Surgery), The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030.
³ Department of Radiology, Methodist Hospital, Houston, TX 77030.

View larger version (122K): [in a new window]   Fig. 1A —Technique for sonography of eye. Radiologists use compact "hockey-stick" linear transducer with patient's eyelid closed. Small amount of gel is sufficient for posterior eye anatomy; standoff pad or abundant gel can be used for anterior chamber.

View larger version (129K): [in a new window]   Fig. 1B —Technique for sonography of eye. Ophthalmologists perform examination after paralyzing blink reflex and scan open eye.

View larger version (107K): [in a new window]   Fig. 1C —Technique for sonography of eye. Ultrasound biomicroscope transducer, operating at 50 MHz, scans through water bath (arrow), incorporated into transducer, which is placed on open eye.

View larger version (71K): [in a new window]   Fig. 2 —Axial cross-section of eye and diagrammatic representation of pathology. C = cornea, A = anterior chamber, L = lens, V = vitreous body, CH = choroid, CB = ciliary body, I = iris, R = retina, S = sclera, CRA = central retinal artery, ON = optic nerve, PCA = posterior ciliary arteries. Sonographic anatomic correlation is shown in Figures 3A, 3B, and 3C; some vascular structures are seen only in Figures 3A, 3B, 3C, 16A, and 16B.

View larger version (67K): [in a new window]   Fig. 3A —Normal eye anatomy. Axial sonograms show normal anterior chamber (A), lens (L), choroid (CH), ciliary body (CB), iris (I), and sclera (S) in A and V = vitreous body (V) and optic nerve (ON) in B.

View larger version (82K): [in a new window]   Fig. 3B —Normal eye anatomy. Axial sonograms show normal anterior chamber (A), lens (L), choroid (CH), ciliary body (CB), iris (I), and sclera (S) in A and V = vitreous body (V) and optic nerve (ON) in B.

View larger version (78K): [in a new window]   Fig. 3C —Normal eye anatomy. Axial color Doppler sonogram shows normal central retinal artery (CRA).

View larger version (132K): [in a new window]   Fig. 4 —34-year-old man with cystic lesion of iris (arrow), illustrated with use of standoff gel pad to visualize anterior eye anatomy. C = cornea, A = anterior chamber, P = posterior chamber, V = vitreous body.

View larger version (148K): [in a new window]   Fig. 5 —47-year-old man with iris melanoma. Ultrasound biomicroscopic image provides better anatomic detail of anterior portion of eye than conventional sonogram shown in Figure 4.

View larger version (141K): [in a new window]   Fig. 6A —52-year-old woman with choroidal melanoma. Typical sonographic features include hypoechoic mass, lobular in shape, with marginal retinal elevation (large arrow). Hyperechoic rim is combination of elevated retina and peripheral blood vessels. Characteristic hypoechoic echotexture is also seen in A-mode scan (graph at bottom), which shows decreased reflectivity between two small arrows corresponding to margins of mass, a feature that sometimes helps distinguish it from other types of tumor (see Figs. 13, 14A, 14B, and 15).

View larger version (101K): [in a new window]   Fig. 6B —52-year-old woman with choroidal melanoma. Funduscopy shows large dark melanoma (large arrows) with peripheral retinal elevation (small arrows), which appears translucent yellow because red color of underlying choroid, seen elsewhere, is lost.

View larger version (78K): [in a new window]   Fig. 7A —45-year-old woman with ciliary body melanoma. Sonogram shows tumor is large and round, which is common for melanoma. C = ciliary body, A = anterior chamber.

View larger version (78K): [in a new window]   Fig. 7B —45-year-old woman with ciliary body melanoma. Color Doppler sonogram shows blood vessels (arrows) encircling and penetrating tumor.

View larger version (117K): [in a new window]   Fig. 7C —45-year-old woman with ciliary body melanoma. Ophthalmoscopy shows dark tumor (arrows) partially obscuring normal "red reflex" of retinochoroidal pigmentation seen through dilated pupil.

View larger version (69K): [in a new window]   Fig. 8 —62-year-old man with melanoma (arrow) arising from ciliary body (C), 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.

View larger version (69K): [in a new window]   Fig. 9 —Complications of melanoma in 56-year-old man with blurred vision. Retinal elevation (small arrows) is caused by tumor mass (large arrow) or by possible transudation of fluid.

View larger version (155K): [in a new window]   Fig. 10 —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.

View larger version (77K): [in a new window]   Fig. 11 —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.

View larger version (147K): [in a new window]   Fig. 12A —55-year-old man with choroidal melanoma. Sonogram shows melanoma (M) before brachytherapy (radiation plaque treatment). Melanoma is biconvex, with slight elevation of retina (arrow) at one margin because of serous fluid transudate.

View larger version (146K): [in a new window]   Fig. 12B —55-year-old man with choroidal melanoma. After radiation plaque treatment, tumor (M) shows significant decrease in volume. Apical tumor dimensions can be obtained using A-mode sonography (not shown).

View larger version (152K): [in a new window]   Fig. 13 —50-year-old woman with primary breast cancer metastasizing to eye. Although flat hyperechoic tumor (long arrow) is morphologically similar to lymphoma (Fig. 15) or treated melanoma (Figs. 12A and 12B), its surface is more irregular, and A-mode sonography (tracing at bottom) shows high reflectivity (short arrows).

View larger version (126K): [in a new window]   Fig. 14A —67-year-old man with metastatic adenocarcinoma from unknown primary site. Tumor is flat hyperechoic mass (arrows), well seen sonographically in nasal field of rotated eyeball.

View larger version (141K): [in a new window]   Fig. 14B —67-year-old man with metastatic adenocarcinoma from unknown primary site. MR image shows subtle, isointense flat mass in nasal aspect of right eye (arrow), which is best seen on this T1-weighted image; T2-weighted images showed similar intensity for tumor and adjacent orbital fat.

View larger version (132K): [in a new window]   Fig. 15 —38-year-old woman with lymphoma. Sonography depicts rather flat mass of moderate echogenicity (long arrow). A-mode sonographic tracing, taken through black-line axis, shows moderate reflectivity (short arrows) that iSs greater than that of melanoma (low reflectivity) but less than that of metastasis (high reflectivity).

View larger version (109K): [in a new window]   Fig. 16A —2-year-old boy with rhabdomyosarcoma of extraocular muscle. Hypoechoic, conical tumor (short arrows) is seen posterior to eye and slightly superior to optic nerve (long black arrow). Retinal detachment is also present (white arrow). Advantages of sonography in this infant outweigh those of MRI because sedation was avoided with minimal loss of anatomic information.

View larger version (103K): [in a new window]   Fig. 16B —2-year-old boy with rhabdomyosarcoma of extraocular muscle. Color Doppler sonogram shows that despite tumor infiltration around optic nerve (arrows), blood flow through central retinal artery (CRA) and posterior short ciliary arteries (PCA) is intact.

View larger version (87K): [in a new window]   Fig. 17A —37-year-old man with hemangioma of orbit. Nasal superior location is common, as seen on this sonogram, which shows superior ophthalmic vein (black arrow) draining hemangioma (white arrows).

View larger version (84K): [in a new window]   Fig. 17B —37-year-old man with hemangioma of orbit. IV contrast-enhanced CT scan of orbits shows prominent draining vessels (arrows) more clearly than sonogram, but repeated irradiation from CT during follow-up was avoided by using sonography, which provided satisfactory images and flow information.

View larger version (64K): [in a new window]   Fig. 17C —37-year-old man with hemangioma of orbit. Color Doppler sonogram shows blood flow of mixed color (arrows), indicating some turbulence in larger vessels of hemangioma in medial aspect of image. Draining ophthalmic vein seen on gray-scale images and CT is not visible, presumably because of low-velocity flow.

View larger version (144K): [in a new window]   Fig. 18A —1-year-old girl with retinoblastoma. Irregular shape of tumor (short arrows) is hard to outline on this sonogram, but hyperechoic calcific foci (long arrow) are characteristic of retinoblastoma.

View larger version (108K): [in a new window]   Fig. 18B —1-year-old girl with retinoblastoma. Large retinoblastoma is cream-colored on funduscopic image and partly overlies optic disk (arrow).

View larger version (115K): [in a new window]   Fig. 19A —37-year-old man with microphthalmos and coloboma. Axial left-to-right sonogram shows abnormally short length of eye (double arrow), posterior defect or coloboma (single arrow), and cyst (C) behind eye.

View larger version (109K): [in a new window]   Fig. 19B —37-year-old man with microphthalmos and coloboma. Abnormality, particularly cyst (C), is better detailed on axial MR image although coloboma is clearer on sonography.

View larger version (83K): [in a new window]   Fig. 20 —32-year-old male iron foundry worker with foreign body in eye, which appears as hyperechoic focus (arrow) in vitreous body of eye.

View larger version (130K): [in a new window]   Fig. 21 —72-year-old man with asteroid hyalosis. Sonogram shows scattered hyperechoic foci (arrow) in central vitreous body.

View larger version (113K): [in a new window]   Fig. 22 —58-year-old man with optic disk drusen. Sonography shows characteristically hyperechoic spots at fundus (arrow) and is particularly helpful in revealing drusen buried in optic nerve, which are otherwise invisible on funduscopy.

View larger version (142K): [in a new window]   Fig. 23 —42-year-old man with retinal detachment. Sonography shows severe posterior, central detachment (arrow). See Figures 6A, 6B, and 9 for other examples of detachment.

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