Ultrasonographic Characteristics of Eyes in Patients with Ocular  Complaints

Jefrin, J; Sushil, V

doi:10.65188/nurexus.1043

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ORIGINAL ARTICLE

Journal of MedVerse Research & Practice

ISSN: 3107-4278

Ultrasonographic Characteristics of Eyes in Patients with Ocular

Complaints

Dr. J Jefrin

1

, Dr. V Sushil

2

Assistant Professor, Associate Professor

Department of Radiodiagnosis, Vinayaka Mission’s Medical College, Karaikal

Email: jeffrinjeya@gmail.com

Submission Date: 27.08.2025

Accepted Date: 24.09.2025

Published Date: 30.09.2025

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: Patients presenting with eye-related complaints can exhibit a wide spectrum of conditions, ranging

from minor visual disturbances to potentially vision-threatening diseases. Traditional evaluation methods, such as

slit-lamp examination and fundoscopy, are often limited in cases where ocular media are opaque. B-scan

ultrasonography (USG) provides a non-invasive, radiation-free imaging option that allows detailed assessment of

intraocular structures in such circumstances.

Objective: To examine the ultrasonographic findings in patients referred for ocular complaints and to evaluate the

clinical utility of B-scan USG in diagnosis and management.

Methods: This descriptive observational study was carried out in the Department of Radiodiagnosis, Vinayaka

Mission’s Medical College, Karaikal, Puducherry, from January to June 2025. A total of 150 patients with suspected

ocular pathology underwent B-scan USG using a linear probe with a frequency range of 5–12 MHz. Parameters

assessed included axial length, lens condition, vitreous, retina, choroid, and optic nerve. Data analysis was performed

using SPSS version 23.0, with categorical variables presented as percentages and continuous variables as mean ± SD.

Results: The study included 150 patients with a mean age of 56.4 ± 15.9 years, comprising an equal number of males

and females. Diminished vision was the most common presenting complaint (99.3%). A majority of patients (78%)

had no prior ocular surgery or history of trauma. The mean axial length of the eyes examined was 23.4 ± 0.6 mm,

with most eyes (98%) falling within the normal range of 22–25 mm. The most frequent ultrasonographic findings

included cataract (30.0%), retinal detachment (17.3%), and vitreous hemorrhage (12.0%). Advanced imaging

techniques were used selectively, with indirect ophthalmoscopy being the most frequently employed (41.3%).

Operative findings correlated completely with USG diagnoses, demonstrating 100% concordance.

Conclusion: B-scan ocular ultrasonography is a dependable, rapid, and cost-effective imaging modality for

evaluating patients with ocular complaints, particularly in situations where conventional examinations are limited by

opaque media. It provides precise diagnostic information, supports surgical planning, and helps avoid unnecessary

interventions. Due to its safety, portability, and high-resolution imaging of superficial ocular structures, B-scan USG

should be regarded as the first-line imaging tool in clinical ophthalmology.

Keywords: Ocular ultrasonography, B-scan ultrasound, Ocular complaints, Cataract

Introduction

Patients presenting with eye-related complaints encompass a wide spectrum, from minor visual

disturbances to conditions that may threaten vision. Prompt and accurate diagnosis is essential to prevent

complications and preserve sight. Traditionally, ocular evaluation has relied on slit-lamp examination and

fundoscopy, which allow clinicians to visualize the anterior and posterior segments of the eye in detail [1].

These methods are non-invasive, can be performed in outpatient settings, and typically cause minimal

discomfort, providing sufficient information for diagnosis and management in most cases.

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However, conventional techniques have limitations, especially when ocular media are opaque. Dense

cataracts, corneal opacities, vitreous haemorrhages, and severe corneal oedema can obstruct the view of

deeper structures, including the retina, choroid, and vitreous cavity [2,3]. Under such circumstances,

relying solely on slit-lamp or fundoscopy may result in delayed or inaccurate diagnosis, highlighting the

need for supplementary imaging methods. Ocular ultrasonography, particularly B-mode scanning, has

become an invaluable adjunct in these scenarios. B-scan ultrasound produces two-dimensional cross-

sectional images of the eye and orbit, enabling visualization of internal structures even when media opacity

prevents direct observation. It is highly sensitive in detecting conditions such as retinal detachment,

vitreous haemorrhage, intraocular tumours, lens dislocation, and foreign bodies, each of which produces

characteristic acoustic patterns on ultrasound [9,10]. Advances in three-dimensional ultrasonography have

further enhanced diagnostic capabilities by allowing volumetric reconstruction of ocular structures for more

detailed evaluation [11].

Compared to other imaging techniques like computed tomography (CT) and magnetic resonance imaging

(MRI), ocular ultrasonography offers several advantages. CT provides high-resolution imaging but involves

radiation exposure, which is a concern in paediatric patients or those requiring repeated scans. MRI delivers

excellent soft tissue contrast but is less accessible, costly, and often requires sedation in children or

uncooperative patients [4]. In contrast, ocular ultrasound is safe, non-invasive, radiation-free, portable, and

cost-effective, making it suitable for both routine and emergency assessments [5–7]. Its portability also

allows bedside imaging in critical care and postoperative settings, enhancing efficiency. The principle of

ultrasonography involves transmitting high-frequency sound waves into the eye, which are reflected

differently by various ocular tissues. These returning echoes are processed to generate detailed images,

enabling differentiation between normal and pathological structures. While A-mode ultrasound is primarily

used for axial length measurements and lens calculations, it provides limited structural detail [8]. B-mode

ultrasound, on the other hand, allows comprehensive visualization of intraocular anatomy—including the

vitreous, retina, and optic nerve—and can be complemented with colour Doppler imaging to assess

vascularity in lesions such as tumours or vascular malformations.

Recent literature highlights the expanding role of ocular ultrasonography in preoperative planning,

postoperative follow-up, trauma evaluation, and detection of intraocular foreign bodies, particularly when

conventional examination methods are inadequate. Studies have demonstrated its ability to detect subtle

pathology, guide clinical decision-making, and reduce the need for more invasive or expensive imaging

[5,6,10]. Its non-invasive nature and minimal patient preparation make it especially useful in paediatric

populations and uncooperative patients. In light of this, the present study was designed to systematically

evaluate ultrasonographic findings in patients referred with ocular complaints. The objectives were:

1. To document ultrasonographic characteristics across a variety of ocular conditions.

2. To assess the diagnostic and management utility of B-mode ultrasound and colour Doppler imaging.

3. To compare postoperative ultrasonographic findings in selected cases to evaluate structural changes and

recovery. Through a detailed analysis of these findings, the study aims to reinforce the importance of ocular

ultrasonography as a reliable, accessible, and cost-effective diagnostic tool, particularly when conventional

examination techniques are insufficient, thereby enhancing clinical decision-making and patient care

outcomes.

Materials & Methods

Study Design

This descriptive observational study was conducted to evaluate the role of B-scan ultrasonography in the

diagnosis of intraocular pathologies among patients presenting with ocular complaints.

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Study Setting and Duration

The study was carried out in the Department of Radiodiagnosis, Vinayaka Mission's Medical College,

Karaikal, Puducherry, over a period of six months, from January 2025 to June 2025. Approval for the study

was obtained from the Institutional Human Ethics Committee (IHEC) prior to commencement.

Study Population

The study population comprised patients referred to the Department of Radiodiagnosis for B-scan

ultrasonography with clinical suspicion of intraocular pathology. Both adult and pediatric patients fulfilling

the eligibility criteria were considered for inclusion.

Sample Size

A total of 150 patients were enrolled consecutively during the study period. (Insert actual sample size.)

Inclusion Criteria

Patients presenting with ocular complaints and referred for B-scan ultrasonography due to suspected

intraocular pathology, who were willing to participate and provided written informed consent, were

included in the study.

Exclusion Criteria

Patients with active ocular surface infections, orbital trauma, ongoing or impending extrusion of ocular

contents, and those unwilling to provide written informed consent were excluded. In pediatric patients,

assent along with parental or guardian consent was mandatory for participation.

Data Collection Tool

Following ethical approval, eligible participants were recruited after obtaining informed consent. Clinical

and demographic information was collected using a pre-tested semi-structured proforma, which included

details regarding age, gender, presenting ocular complaints, relevant medical history, clinical examination

findings, and referral diagnosis. All participants underwent B-scan ultrasonography using a high-frequency

linear transducer (5–12 MHz) under standardized examination protocols. Ocular ultrasonography was

performed with the patient in the supine or sitting position after applying sterile coupling gel over the

closed eyelid. Real-time dynamic scanning was performed in multiple planes to obtain comprehensive

evaluation of both the anterior and posterior segments of the globe. Morphometric measurements, including

axial length, were recorded for each eye. A systematic assessment was performed to evaluate the lens,

vitreous cavity, retina, choroid, posterior segment, optic nerve, and surrounding orbital structures.

Characteristic sonographic features such as vitreous opacities, retinal detachment, vitreous hemorrhage,

choroidal detachment, posterior vitreous detachment, intraocular masses, lens abnormalities, and optic

nerve lesions were documented. The ultrasonographic findings were subsequently correlated with the final

clinical diagnosis established through ophthalmological examination and relevant ancillary investigations.

Ethical Considerations

The study protocol was reviewed and approved by the Institutional Human Ethics Committee before

initiation of the study. Written informed consent was obtained from all adult participants. For pediatric

participants, written parental consent along with child assent was obtained wherever appropriate.

Participation in the study imposed no additional financial burden or procedural risk beyond routine clinical

evaluation. Confidentiality and anonymity of all patient information were maintained throughout data

collection, analysis, and reporting. The study was conducted in accordance with the ethical principles

outlined in the Declaration of Helsinki.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS software version 23.0. Categorical

variables were expressed as frequencies and percentages, while continuous variables were presented as

mean ± standard deviation (SD) or median with interquartile range (IQR) depending on data distribution.

Normality of continuous variables was assessed using the Kolmogorov–Smirnov test. Comparisons of

quantitative variables were performed using the paired Student's t-test, whereas qualitative variables were

analyzed using the Chi-square test or Fisher's exact test whenever appropriate. A p-value less than 0.05 was

considered statistically significant.

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Results

Table 1: Baseline Characteristics of Patients with Ocular Complaints (N = 150)

Characteristic

Number (%)

Age (years)

31–50 years

33 (22.0)

51–70 years

87 (58.0)

>70 years

30 (20.0)

Sex

Male

75 (50.0)

Female

75 (50.0)

Presenting complaints

Diminished vision

149 (99.3)

Pain

14 (9.3)

Redness

8 (5.3)

Discharge

7 (4.7)

History of surgery/trauma

None

117 (78.0)

Trauma

16 (10.7)

Post cataract surgery

15 (10.0)

Post-retinal detachment surgery

2 (1.3)

Comorbidities

Diabetes mellitus

42 (28.0)

Hypertension

27 (18.0)

Both DM & HTN

3 (2.0)

Laterality of involvement

Right eye

69 (46.0)

Left eye

66 (44.0)

Both eyes

15 (10.0)

In this study of 150 patients, the majority were between 51–70 years (58%), with an equal distribution of

males and females. The most frequent presenting symptom was diminished vision (99.3%), followed by

pain (9.3%), redness (5.3%), and discharge (4.7%). Most patients (78%) had no prior history of surgery or

trauma, while 10.7% reported trauma and 10% had undergone cataract surgery. Regarding comorbidities,

diabetes (28%) was more common than hypertension (18%), with 2% having both. Laterality showed

almost equal involvement of right (46%) and left eyes (44%), with 10% having bilateral disease.

Table 2. Axial Length and Lens Status in Involved Eyes (N = 150)

Parameter

Number (%)

Details

Axial length (mm)

Mean (SD): 23.4 (0.6), Range: 21.1 – 27.3

<22 mm

2 (1.3)

Rare

22–25 mm

147 (98.0)

Majority

>25 mm

1 (0.7)

Rare

Lens status

—

Normal location

132 (88.0)

—

Dislocated/subluxated

8 (5.3)

—

Absent (aphakia)

10 (6.7)

—

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In this study of 150 eyes, the mean axial length was 23.4 mm (SD: 0.6; range 21.1–27.3 mm). The vast

majority (98%) fell within the normal range of 22–25 mm, with only 1.3% measuring below 22 mm and

0.7% above 25 mm. Regarding lens status, most eyes (88%) had a normally positioned lens, while 5.3%

showed dislocation/subluxation and 6.7% were aphakic (absent lens).

Figure 1: Ultrasonographic Diagnoses in Involved Eyes (N = 150)

*Rare cases include: old RD with cyst, optic glioma, posterior staphyloma, RD with subretinal hemorrhage,

phthisis bulbi, uveitis, and VH with neovascular glaucoma.

The most common diagnosis was cataract seen in 45 eyes (30.0%), followed by retinal detachment (26

eyes, 17.3%) and vitreous hemorrhage (18 eyes, 12.0%). Combined conditions included cataract with

posterior vitreous detachment (11 eyes, 7.3%) and retinal detachment with vitreous hemorrhage (5 eyes,

3.3%). Other diagnoses were aphakia (10 eyes, 6.7%), dislocated/subluxated lens (8 eyes, 5.3%), posterior

vitreous detachment alone (5 eyes, 3.3%), choroidal detachment (4 eyes, 2.7%), and retinoschisis (3 eyes,

2.0%). Rare single presentations, including isolated conditions, were noted in 6 eyes (4.0%). Interestingly,

no abnormality was detected in 6 eyes (4.0%).

Table 3. Other Diagnostic Modalities Used (N = 150)

Modality

Number (%)

Indirect ophthalmoscopy

62 (41.3)

Direct ophthalmoscopy

57 (38.0)

Both direct + indirect ophthalmoscopy

24 (16.0)

Optical coherence tomography (OCT)

3 (2.0)

Fundus fluorescein angiography (FFA)

2 (1.3)

Slit lamp + indirect ophthalmoscopy

1 (0.7)

Operative confirmation

100% concordance with USG findings

Among the 150 patients, the most frequently used technique was indirect ophthalmoscopy (62 eyes,

41.3%), followed closely by direct ophthalmoscopy (57 eyes, 38.0%). A combination of direct and indirect

ophthalmoscopy was employed in 24 eyes (16.0%), while advanced imaging modalities such as optical

coherence tomography (3 eyes, 2.0%) and fundus fluorescein angiography (2 eyes, 1.3%) were used less

frequently. A single case (0.7%) required slit lamp examination combined with indirect ophthalmoscopy.

Notably, in cases that underwent surgical intervention, there was 100% concordance between operative

findings and ultrasonography (USG) results, highlighting the reliability of USG as a diagnostic tool in

ocular evaluation.

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Discussion

This study aimed to assess the diagnostic value of ocular B-scan ultrasonography in patients referred with

suspected intraocular pathology to the Department of Radiodiagnosis from January to June 2025. A

comprehensive evaluation of the lens, vitreous, retina, choroid, and optic nerve was performed in all cases.

A total of 150 patients were included, some with bilateral involvement, resulting in a larger number of eyes

analyzed. Notably, all ultrasonographic findings were fully consistent with intraoperative diagnoses,

demonstrating 100% accuracy in this cohort. These findings are consistent with earlier studies. Yang et al.

demonstrated complete agreement between immersion 20-MHz B-scan ultrasonography and clinical

findings in alkali burn eyes, reporting 100% concordance for lens pathology [12]. Similarly, Shazlee et al.

reported a diagnostic accuracy of 98% for B-scan ultrasonography in ocular trauma, highlighting its

reliability as a primary imaging modality in emergency and high-burden clinical settings [15].

In the present study, the most common surgical intervention was lensectomy with intraocular lens

implantation, followed by vitrectomy with membrane peeling, endolaser, and tamponade procedures.

Postoperative follow-up showed that more than half of the eyes achieved improved visual outcomes. B-

scan ultrasonography proved especially valuable for preoperative planning in cases with opaque ocular

media, where direct fundus visualization was not possible, a benefit also emphasized by De La Hoz Polo et

al. [11].

Despite its advantages, certain limitations should be considered. Ultrasound image interpretation is

operator-dependent, and this study relied on a single experienced radiologist, potentially limiting

generalizability. Inter-observer variability was not assessed, and the radiologist was aware of the patients’

clinical details, introducing possible observer bias—although this reflects real-world clinical practice.

Furthermore, as this study was conducted in a tertiary care teaching hospital, the findings may not fully

represent community-level populations.

Nevertheless, the results reinforce the role of ocular B-scan ultrasonography as a safe, non-invasive, rapid,

and cost-effective diagnostic tool. It is particularly useful in patients with opaque media, enabling accurate

visualization of the posterior segment and early detection of vitreoretinal detachments, intraocular tumors,

and hemorrhages, as supported by Abramowicz et al. [7]. While CT and MRI retain importance in selected

orbital and neuro-ophthalmic conditions, they cannot replace ultrasonography for superficial ocular

structures due to its superior resolution, bedside availability, and absence of ionizing radiation.

Conclusion

Ocular B-scan ultrasonography is a highly effective diagnostic modality for evaluating patients with ocular

complaints, especially when conventional examinations are limited by opaque media. It is non-invasive,

readily available, cost-effective, and capable of providing rapid, accurate diagnoses. In this study,

ultrasonography demonstrated excellent concordance with operative findings, reliably differentiating

between various ocular detachments, vitreoretinal disorders, and intraocular lesions. Operator expertise is

essential for accurate interpretation, and while color Doppler has limited utility in most ocular conditions,

B-scan remains indispensable as a first-line imaging tool. Its use facilitates timely and appropriate clinical

management, optimizes surgical planning, and minimizes unnecessary procedures, reinforcing its role as a

cornerstone in ophthalmic diagnostics.

Conflict of Interest: Nil

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