Change in Intraocular Pressure During Point-of-Care Ultrasound

Abstract

IntroductionPoint-of-care ocular ultrasound (US) is a valuable tool for the evaluation of traumatic ocular injuries. Conventionally, any maneuver that may increase intraocular pressure (IOP) is relatively contraindicated in the setting of globe rupture. Some authors have cautioned against the use of US in these scenarios because of a theoretical concern that an US examination may cause or exacerbate the extrusion of intraocular contents. This study set out to investigate whether ocular US affects IOP. The secondary objective was to validate the intraocular pressure measurements obtained with the Diaton® as compared with standard applanation techniques (the Tono-Pen®).MethodsWe enrolled a convenience sample of healthy adult volunteers. We obtained the baseline IOP for each patient by using a transpalpebral tonometer. Ocular US was then performed on each subject using a high-frequency linear array transducer, and a second IOP was obtained during the US examination. A third IOP measurement was obtained following the completion of the US examination. To validate transpalpebral measurement, a subset of subjects also underwent traditional transcorneal applanation tonometry prior to the US examination as a baseline measurement. In a subset of 10 patients, we obtained baseline pre-ultrasound IOP measurements with the Diaton® and Tono-Pen®, and then compared them.ResultsThe study included 40 subjects. IOP values during ocular US examination were slightly greater than baseline (average +1.8mmHg, p=0.01). Post-US examination IOP values were not significantly different than baseline (average −0.15mmHg, p=0.42). In a subset of 10 subjects, IOP values were not significantly different between transpalpebral and transcorneal tonometry (average +0.03mmHg, p=0.07).ConclusionIn healthy volunteer subjects, point-of-care ocular US causes a small and transient increase in IOP. We also showed no difference between the Diaton® and Tono-Pen® methods of IOP measurement. Overall, the resulting change in IOP with US transducer placement is considerably less than the mean diurnal variation in healthy subjects, or pressure generated by physical examination, and is therefore unlikely to be clinically significant. However, it is important to take caution when performing ocular ultrasound, since it is unclear what the change in IOP would be in patients with ocular trauma.

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

“…If there is a possibility of globe rupture, a thick layer of gel should be used to prevent contact between the eyelid and transducer. A study of 40 patients demonstrated small, transient elevation in intraocular pressure during ocular POCUS, but pressure change was similar to that caused by physical exam [88]. …”

Orbital compartment syndrome: Pearls and pitfalls for the emergency physician

“…however, more research is needed to determine the role of color flow and pulsed wave doppler in OCS and traumatic retrobulbar hemorrhage. 62 and the use of a plastic shield may further diminish any increases in IOP. 63 In a clinical review based on 8 cases of globe rupture, ultrasound had 100% sensitivity and 99% specificity, 64 whereas an animal model reported 79% sensitivity and 51% specificity.…”