3\ Axial Scanning of the Eye

Globe. See Fig. 1.5

Fig. 1.5  The axial section of the eye globe. Note: 1 cornea, 2 anterior chamber, 3 iris, 4 lens, 5 vitreous body, 6 eyeball, 7 optic nerve

3.1\ Scanning Method

High-frequency linear array transducer probe can be used to get an axial image of the eye globe from the corneal vertex to the optic nerve, with the patient lying flat on his/her back, the eye

looking upward, and the probe is placed in a horizontal manner. In case the peripheral of the globe cannot be imaged clearly, you can tell the patient to move his/her eyes from side to side so that it can be imaged clearly.

3.2\ Sectional Structure

Cornea, anterior chamber, iris, lens, vitreous body, walls of the eyeball, optic nerve, extraocular muscle, etc.

3.3\ Measuring Method

and Normal Value

It is generally the axial length of the eye globe that is measured, with the distance between the top of the cornea and the wall of the eye 3 mm adjacent to the optic disk as the reference point. Normal value is 23.5–24.5 mm. Two-dimensional ultrasound is not recommended for measuring anterior chamber depth, thickness of lens, length of vitreous, etc.

3.4\ Clinical Value

Ultrasonography is one of the most helpful diagnostic methods for ocular disease, especially for patients whose fundus cannot be seen clearly with routine inspection methods. It is also one of the most helpful diagnostic methods for refractive interstitial opacity, trauma, and tumor.

4\ Sonogram of the Normal

Lacrimal Gland. See Fig. 1.6

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2

3

Fig. 1.6  Sonogram of the normal lacrimal gland. Note: 1 lacrimal gland, 2 vitreous body, 3 eyeball

4.1\ Scanning Method

The probe is placed in a horizontal manner toward the superior temporal of the eye globe so that the palpebral portion of the lacrimal gland can be imaged. The orbital portion of the lacrimal gland can’t be imaged completely and clearly because of the shelter from the orbital bone.

4.2\ Sectional Structure

The palpebral portion of the lacrimal gland produces a weak echo triangle above the superior temporal of the eye in two-dimensional ultrasound, with clear boundaries between axial tissues and strong echo light dots evenly distributed inside.

4.3\ Measuring Method

and Normal Value

The maximum diameter of the lacrimal gland can be measured after the structure of the lacrimal gland is clearly imaged. The anatomical size of the orbital portion is 10 mm × 20 mm, while the palpebral-portioned lacrimal gland is somewhere between one third and one half. The structure of ultrasound measurement is limited by its capability to image the lacrimal gland which is generally smaller than its anatomical size.

4.4\ Clinical Value

Sonography is clinically useful in diagnosing lacrimal gland disease, which, in particular, has unique features for diagnosing the palpebral-­portioned lacrimal gland disease. Sphere techniques can be used to observe the orbital portion if the lesion is big or if it affects the orbit. Based on the exam results of the palpebral portion and the orbital portion, we can get a comprehensive understanding of lacrimal gland disease.

5\ Normal Sonogram

of the Extraocular Muscles.

See Fig. 1.7

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2

3

4

Fig. 1.7  Normal sonogram of the extraocular muscles. Note: 1 cornea, 2 vitreous body, 3 eyeball, 4 extraocular muscle

5.1\ Scanning Method

The vertical scanning is used. The probe is placed opposite from the muscle being examined and the probe calibration toward the center of the cornea and the muscle being examined. The place is put vertically to scan the corneal limbus back and forth to display the long axial image of the muscle.

1\ .\ Medial rectus: The patient is asked to look straight ahead. Scanning is performed from the outer canthal region.

\2.\ Lateral rectus muscle: Scanning is performed from the nasal side. If the nose hinders the exam, ask the patient to move the eyeball 10° outward.

\3.\ Inferior rectus: Ask the patient to move the eyeball 10° downward and place the probe above the eye to exam.

\4.\ Superior and levator palpebrae superioris muscle: Place the probe below the eyeball. Two weak reflection structures can be detected; however, it is not easy to distinguish.

5.2\ Sectional Structure

Ultrasonic scans can show the dark muscle bands from the peripheral of the eyeball to the behind. The boundary is clear because of the fascia between the muscle and other orbit tissue.

5.3\ Measuring Method

and Normal Value

Measurement is based on vertical scanning of the extraocular muscle. Measurements are performed at the posterior 1/3 of the muscle.

The thickness of the normal extraocular muscle. See Table 1.2.

Table 1.2  The thickness of the normal extraocular muscle

5.4\ Clinical Value

The value of using ultrasonography to determine the thickness of the extraocular muscle is still arguable. The author does not recommend this method because the repeatability and accuracy of this measurement are not very satisfactory. However, this measurement is considered to be useful for the observation of inflammation, tumor, and other orbital disorders involving the extraocular muscle. If the thickness of the extraocular muscle is measured merely to diagnose relevant diseases such as dysthyroid ophthalmopathy, it’s better to run a MRI to get a more direct and reliable result.

The globe should be scanned in transverse planes. The optic nerve should be identified clearly to locate the orbit vessels. The Doppler sample gate is set 15–25 mm posterior to the globe in the OA, which is located along the optic nerve and is similar to the letter “S.” Set the Doppler sample gate 2–5 mm posterior to the globe in the CRA and CRV which are in the center of the optic nerve. Set the Doppler sample gate 5–8 mm posterior to the globe in the PCA beside the optic nerve.

Color blood flow imaging can be seen in the orbit. Generally, it is the ophthalmic artery (OA) that can be located with color Doppler imaging by scanning the optic nerve on the nasal sides 15 mm posterior to the globe. The red and blue blood flow in the optic nerve is the central retinal artery (CRA) and central retinal vein (CRV). The clustered blood flow adjacent to the optic nerve is PRA. While SOV cannot be identified in every patient, it can be located between the medial rectus and optic nerve in the orbit.