Ultrasound of the eye - Part 2: Fundamentals of posterior wall detachment

Detachment of the posterior membranes of the eye may occur following trauma or surgery, can result from certain disease processes or just be attributed to the aging process. Irrespective of the cause, all can contribute to visual disturbance. Failure to diagnose and treat such conditions can have permanent effects on a patient's vision if not addressed in a timely manner. Ultrasound proves to be a useful tool to aid in the diagnosis of posterior wall detachments when the operator has a thorough knowledge of ocular structure and function, anatomical landmarks and the common sonographic appearances that differentiate the type of membrane involved in the disease process. Although ocular ultrasound has historically been performed in the emergency or ophthalmology settings, the incidence of ocular ultrasound being undertaken in radiology departments is increasing. Multiple recent studies have observed an increase in the incidence of retinal detachment, the main causative factors being linked to a higher prevalence of myopia and cataract surgeries. The purpose of this article therefore is to provide a comprehensive guide to the anatomical structure of the posterior orbital segment, including surface anatomy and attachment points, and how this can facilitate the correct identification of the different types of posterior membranous detachment based on common sonographic appearances. As such, operators skilled in performing ultrasound of the eye can play a pivotal role in ensuring an appropriate management pathway is achieved by way of accurate interpretation of pathological ultrasound images.