College of

Remote and Offshore Medicine

CoROM

Austere and Prehospital

Ultrasound (APUS)™

h"ps://corom.edu.mt/
 https://corom.edu.mt/
Ocular
Ultrasound

Ultrasound of the eye can iden2fy a range of pathologies.

The lens can be visualised and confirmed in posi2on. Re2nal

detachments can be visualised, as can vitreous haemorrhages
and posterior vitreous detachments.

The op2c nerve and its sheath can also be visualised, and their
measurement correlates to intracranial pressure.

• Eyelid
• Anterior Chamber
• Iris
• Lens
• Posterior Chamber
• Retina
 h"ps://corom.edu.mt/
Ocular
Ultrasound

Measurement of the op2c nerve sheath diameter (ONSD)

correlates with raised intracranial pressure (ICP).

Op2c nerve sheath diameter >5mm appears to have diagnos2c

sensi2vity of 95.6% and specificity of 92.3% for raised
intracranial pressure (Ohle et al 2015).

An op2c nerve sheath diameter of >5mm appears to correlate

well with an intracranial pressure >20 mmHg.

Eleva2on of the op2c disc of >0.6mm has a sensi2vity of around

82% and a specificity of about 76% for
Papilloedema (Teismann et al 2013). This distance is measured
from the anterior peak of the disc and its
intersec2on to the posterior surface of the
globe. We consider iden2fying op2c disc
eleva2on to be harder than measuring the
op2c nerve sheath diameter.
Ohle R, McIsaac SM, Woo MY, Perry JJ. Sonography of the Op;c Nerve Sheath Diameter
for Detec;on of Raised Intracranial Pressure Compared to Computed Tomography: A
Systema;c Review and Meta-analysis. J Ultrasound Med. 2015 Jul;34(7):1285-94.

Teismann, N., Lenaghan, P., Nolan, R., Stein, J., & Green, A. (2013). Point-of-care ocular
ultrasound to detect op;c disc swelling. Academic Emergency Medicine, 20(9), 920-925.
 https://corom.edu.mt/
Ocular
Ultrasound

The procedure for undertaking ocular

ultrasound is fairly straighXorward.

A high frequency linear probe (5-18 MHz)

should be selected. Ensure the chosen
probe is safe for ocular ultrasound (we use
the Bu5erfly IQ / IQ+).

The pa2ent is posi2oned supine and

consent is gained.

The pa2ent is directed to keep their eyes

closed, and sterile ultrasound gel is placed
on their closed eyelid.

The probe is then applied to the gel while

the operator anchors their hand to the
pa2ents forehead, orbit or nasal bone to
avoid pressure to the globe.

The probe is manipulated to gain the best

view using transverse or sagi]al views.
 https://corom.edu.mt/
Ocular
Ultrasound

Measurement 1 is used to locate how

deep to the retina you will measure
the diameter of the optic nerve
sheath.
We always measure 3 mm posterior
to the globe.

Measurement 2 is the measured op2c

nerve sheath diameter (ONSD).
A normal ONSD is ≤5mm.

Elevated op2c disc is clearly visible in

this ultrasound image.

*
 https://corom.edu.mt/
APUS™
Course
The College of Remote and Offshore Medicine has developed a
point-of-care ultrasound course called Austere and Prehospital
Ultrasound (APUS)™. The APUS course comprises an eLearning
component and subsequent face-to-face teaching to allow
learners hands-on prac2ce 2me to develop their ultrasound
skills.
Find out more and book here
h]ps://corom.edu.mt/apus/
Indicative timetable for a face-to-face APUS course
Day 1 Day 2

0800-0830 Course Introduction Course Review

0830-1200 eFAST (Extended Focussed Sonography in Trauma)

•Lung Heart and Lung
1000-1100
•Heart (Briefly)
1100-1200 •Abdomen Open Practice

1200 Lunch

1300-1400 IVC Measurement Optic Nerve Sheath Measurement

1400-1500 AAA Assessment Airway Ultrasound / Open Practice

1500-1600 Vascular Access Prolonged Field Care / Open Practice

1600-1700 Open Practice Open Practice

h"ps://corom.edu.mt/medicine-in-the-mediterranean-conference/