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Eyes

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Abstract

Ultrasonography has become a standard imaging modality in ophthalmology and is routinely used as the first imaging technique for evaluation of ocular and orbital structures. Ultrasonography allows for detection and evaluation of intraocular or orbital neoplastic and non-neoplastic lesions; detection of intraocular changes such as lens luxation and/or retinal detachment in opaque eyes; measurements of the dimensions of the lens, anterior chamber and globe; and evaluation of traumatic injuries to the eye and orbit. This chapter covers the value of ultrasonography compared with radiography and computed tomography, imaging technique, normal ultrasonographic appearance followed by intraocular and orbital abnormalities.

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Figures

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18.1 Horizontal plane ultrasonogram of the normal eye of a 5-year-old Standard Poodle.
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18.2 Horizontal plane ultrasonogram of the iridocorneal angle (arrowed) of the normal eye of a 5-year-old Standard Poodle.
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18.3 Horizontal plane ultrasonogram of the eye of a 3-year-old mixed-breed dog with corneal oedema following injury to the eye. There is thickening of the mid-region of the cornea with increased echogenicity of the corneal stroma. Note also the echogenic strand (arrowed) connecting the posterior aspect of the cornea with the anterior lens capsule.
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18.4 Transverse image obtained from the dorsal aspect of the anterior section of the eye of a 10-year-old Domestic Shorthaired cat. Two cysts are visible at the anterior aspect of the iris, appearing as anechoic, round structures with an echogenic wall. Power Doppler ultrasonogram showing only vascularization of the walls of the cysts and not of the centre.
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18.5 Horizontal plane ultrasonogram showing nuclear sclerosis in a 9-year-old mixed-breed dog. The nuclear sclerosis is visible as a curvilinear hyperechoic line running parallel with the anterior (arrowed) and posterior lens capsule.
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18.6 Vertical plane ultrasonogram of the eye of a 1-year-old Golden Retriever with a juvenile cataract. Note the decreased anterior–posterior diameter (between the callipers) and the increased echogenicity of the lens nucleus. The other intraocular structures are within normal limits. Biometric measurements have been performed. Horizontal plane ultrasonogram of the eye of a 5-year-old Cavalier King Charles Spaniel with diabetes mellitus and secondary cataract formation. Note the increased anterior–posterior diameter and the increased echogenicity of the lens nucleus.
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18.7 Vertical plane ultrasonogram of the eye of a 7-year-old Golden Retriever presented with a cataract. Note the increased echogenicity of the nucleus of the lens. There is a rupture of the posterior lens capsule indicated by the presence of lenticular tissue (arrowed) adjacent to the posterior lens capsule with interruption of the posterior lens capsule.
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18.8 Horizontal plane ultrasonogram of the right eye of an 8-year-old mixed-breed dog presented with cataracts and suspected lens luxation. Subluxation of the lens is indicated by its asymmetrical position within the anterior segment. The distance between the cornea and anterior lens capsule is wider at the medial aspect compared with the lateral aspect. Horizontal plane ultrasonogram of the left eye. There is complete posterior luxation of the lens, which is located in the posterior chamber.
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18.9 Ultrasonogram of the eye of a 9-year-old Golden Retriever presented with hyphaema. The anterior chamber and the vitreous body are echogenic due to the presence of blood cells. The echogenic structures visible within the anterior and posterior aspect of the lens are compatible with a cataract.
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18.10 Vertical plane ultrasonogram of the eye of a 5-year-old Labrador Retriever with a cataract presented for preoperative evaluation. There is a total V-shaped retinal detachment (arrowed). Within the anterior segment of the eye, an oblique section of the complete opacified lens is visible.
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18.11 Horizontal plane ultrasonogram of the eye of a 6-year-old Boxer presented with glaucoma. There is an elevation of the retina visible on the medial and lateral aspects of the globe (arrowed). The subretinal material appears echogenic, compatible with subretinal bleeding.
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18.12 Horizontal plane ultrasonogram of the eye of a 1-year-old Dobermann presented with a left-sided cataract and suspected microphthalmia. A small hyperechoic lens (L) is visible with a linear hyperechoic strand running from the posterior aspect of the lens to the optic nerve head. Note the triangular-shaped posterior lens capsule showing mild lenticonus. Horizontal plane ultrasonogram of the eye of a 9-month-old mixed-breed dog with a cataract and suspected microphthalmia. There is a hyperechoic linear strand running from the posterior aspect of the lens to the optic nerve head. Note the increased echogenicity at the medial aspect of the posterior lens nucleus and the power Doppler signal within the hyperechoic strand. These findings are compatible with a cataract and patent hyaloid artery.
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18.13 Horizontal plane ultrasonogram of the anterior aspect of the eye of a 7-year-old Flat-coated Retriever. Note the echogenic thickening of the medial aspect of the iris, extending to the ciliary body. The echogenic and enlarged iris/ciliary body are compatible with neoplasia, such as melanoma or adenocarcinoma. Horizontal plane ultrasonogram of the eye of a 4-year-old Shih Tzu suspected of having a ciliary tumour. Colour flow Doppler demonstrates vascularization within a limbal mass at the lateral aspect of the ciliary body. Pathology confirmed a limbal melanoma.
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18.14 Horizontal plane ultrasonogram of the orbit of a 7-year-old mixed-breed dog presented with painful unilateral exophthalmos. The orbital fat (*) is more hyperattenuating and the optic nerve and extraocular muscles are less well defined than usual. The optic head is mildly elevated (arrowed). These changes are suggestive of orbital inflammation.
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18.15 Transverse image of the orbit of a 3-year-old Domestic Shorthaired cat from a dorsal approach. The near-field shows an indention (arrowed) of the posterior aspect of the scleroretinal rim. Note the mass lesion (M), which has a thick and irregular echogenic wall surrounding a more hypoechoic centre. These changes are compatible with an abscess.
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18.16 Horizontal plane ultrasonogram of the orbit of a 3-year-old mixed-breed dog presented with painful bilateral exophthalmos. Note the severe thickening and hypoechoic appearance of the extraocular muscles (*), together with the ill defined margins. In addition, the orbital fat appears more hyperattenuating than usual. These changes are compatible with extraocular polymyositis. Differential diagnosis includes lymphoma of the extraocular muscles. (Courtesy of the Department of Surgical and Radiological Sciences, University of California-Davis)
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18.17 Longitudinal plane ultrasonogram, from a dorsal approach, of the orbital space of a 9-year-old Irish Terrier presented with non-painful unilateral left-sided exophthalmos. There is a well defined hypoechoic mass (M) visible at the caudal aspect of the eye with indention of the posterior aspect of the globe. The well defined margins and hypoechoic aspect should raise suspicion for neoplasia.
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18.18 Transverse image, from a dorsal approach caudal to the eye, of a 10-year-old Siberian Husky presented for mild unilateral left-sided nasal discharge and exophthalmos. the normal right orbital space is shown using the temporal muscles as an acoustic window. Note the hyperechoic line (arrowed) representing the medial orbital wall. the abnormal left orbital space. Note the irregular hypoechoic mass extending medially beyond the margins of the medial orbital wall. There are interruptions within the hyperechoic margin of the medial orbital wall (arrowed), representing severe osteolysis. Transverse CT image illustrating the extension of the bony lysis and mass lesion. Pathology confirmed an adenocarcinoma.
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18.19 Horizontal plane ultrasonogram of the eye of a 4-year-old Welsh Springer Spaniel showing a severe hypoechoic thickening of the optic nerve head (arrowed) and proximal optic nerve. Differential diagnoses include granulomatous optic nerve neuritis and neoplasia. Pathology confirmed the diagnosis of a meningioma.

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