Research Article
Volume 4 Issue 7 - 2020
Optic Nerve Sheath Diameter in Retrobulbar Ultrasound as a Surrogate Measure for Intracranial Pressure Before and After Non-Invasive Strategies
Aldo Saad Diab1*, Benailim Martínez1, Albana Gámez1 and Yvan Bucott2
1Department of Anaesthesiology, "Dr. Miguel Pérez Carreño" Hospital, Caracas, Venezuela
2Department of Neurosurgery, "Dr. Miguel Pérez Carreño" Hospital, Caracas, Venezuela
*Corresponding Author: Aldo Saad Diab, Department of Anaesthesiology, "Dr. Miguel Pérez Carreño" Hospital, Caracas, Venezuela.
Received: December 28, 2019; Published: June 30, 2020


Background: Raised intracranial pressure is a complication that leads to adverse outcomes. In the critically ill, invasive measurement by an intraventricular catheter is the gold standard; its use in non-specialized centers is limited, besides neuroimaging by computed tomography or magnetic resonance imaging scans entail transfer of a critically ill patient out of the ICU. Dilatation of the optic nerve sheath has been shown to be a much earlier manifestation of ICP rise. The optic nerve sheath diameter (ONSD) is fairly easy to visualize by ultrasonography by insonation across the orbit.

Methods: 90 patients, divided into three groups. Group M received mannitol 20% 0.5 gr kg-1, Group H received NaCl 7.5% 1.5 ml kg-1 and Group P patients were positioned on reverse Trendelenburg position 30 degrees. ONSD was measured 3 mm behind the optic disc. The measurements T1 before and T2 after the strategies according to group 30 minutes T3 at 60 minutes and T4 at 90 minutes.

Results: Similar trend between invasive monitoring and ONSD measurement was observed. Invasive measurement the intracranial pressure was 40.2 at T1; there was a sustained and significant decrease in the three groups at 30, 60 and 90 minutes. ONSD measured at baseline, average was 7.0mm in group M, 7.1 in group H and 6.7 in group P and subsequently it was significantly reduced at 30, 60 (p = 0.002) and 90 minutes (p = 0.003).

Conclusion: ONSD in retrobulbar ultrasound is a reliable method to detect intracranial pressure variations before and after non-invasive strategies to reduce it acutely.

Keywords: Intracranial Hypertension; Intracranial Pressure; Optic Nerve Sheath Diameter; Osmotherapy; Reverse Trendelenburg Position


  1. Sadik Girisgin A., et al. “The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure”. Emergency Medicine Journal 24 (2007): 251-254.
  2. Newman WD., et al. “Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus”. British Journal of Ophthalmology 86.10 (2002): 1109-1113.
  3. Zhang X., et al. “Invasive and noninvasive means of measuring intracranial pressure: a review”. Physiological Measurement 38.8 (2017): R143-R182.
  4. Das S., et al. “A Novel Triage Tool: Optic Nerve Sheath Diameter in Traumatic Brain Injury and its Correlation to Rotterdam Computed Tomography (CT) Scoring”. Polish Journal of Radiology 82 (2017): 240-243. 
  5. Bellal J., et al. “Non-invasive diagnosis and treatment strategies for traumatic brain injury: an update”. Journal of Neuroscience Research (2017): 1-12.
  6. Khan MN., et al. “Noninvasive monitoring intra-cranial pressure - A review of available modalities”. Surgical Neurology International 8 (2017): 1-11.
  7. García JR., et al. “Monitoring of intracranial pressure in severe craniocephalic trauma: clinical experience”. Revista Chilena de Pediatría 87.5 (2016): 387-394.
  8. Raboel PH., et al. “Intracranial Pressure monitoring : invasive versus non-invasive methods, a review”. Critical Care Research and Practice (2012): 1-14.
  9. Ozturk T., et al. “Assessment of intra-interobserver reliability of the sonographic optic nerve sheath diameter measurement”. The Kaohsiung Journal of Medical Sciences 31.8 (2015): 432-436.
  10. Smith M. “Monitoring intracranial pressure in traumatic brain injury”. Anesthesia and Analgesia 106.1 (2008): 240-248.
  11. Akopian G., et al. “Outcomes of blunt head trauma without intracranial pressure monitoring”. American Surgeon 73.5 (2007): 447-450.
  12. Sahuquillo J., et al. “Updates on the pathophysiology and monitoring of severe head injuries”. Neurosurgery 8 (1997): 260-283.
  13. Blaivas M., et al. “Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath”. Academic Emergency Medicine 10.4 (2003): 376-381.
  14. Jang T and Aubin C. “The use of serial ocular ultrasonography in the care of patients with head injury”. Annals of Emergency Medicine 45.3 (2005): 336-337.
  15. Gangemi M., et al. “Echographic measurement of the optic nerve in patients with intracranial hypertension”. Acta Neurochirurgica 30 (1987): 53-55. 
  16. Tayal VS., et al. “Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients”. Annals of Emergency Medicine 49.4 (2007): 508-514.
  17. Chen H., et al. “Ultrasound measurement of optic nerve diameter and optic nerve sheath diameter in healthy Chinese adults”. BMC Neurology 15 (2015): 106.
  18. Wang L., et al. “Ultrasonographic Evaluation of Optic Nerve Sheath Diameter among Healthy Chinese Adults”. Ultrasound in Medicine and Biology 42.3 (2016): 683-688. 
  19. Smith E and Hanjani S. “Evaluation and management of elevated intracranial pressure in adults”. In Aminoff M, ed. UpToDate. Waltham, MASS: UpToDate Inc (2019). 
  20. Dubourg J., et al. “Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis”. Intensive Care Medicine 37.7 (2011): 1059-1068.
  21. Geeraerts T., et al. “Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury”. Intensive Care Medicine 33.10 (2007): 1704-1711. 
  22. Launey Y., et al. “Effect of osmotherapy on optic nerve sheath diameter in patients with increased intracranial pressure”. Journal of Neurotrauma 31.10 (2014): 984-988.
  23. Wang L., et al. “Ultrasonography assesments of optic nerve sheath diameter as a noninvasive and dynamic method of detecting changes in intracranial pressure”. Journal of American Medical Association Ophthalmology 136.3 (2018): 250-256.
  24. Killer H., et al. “Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations”. British Journal of Ophthalmology 87.6 (2003): 777-781.
  25. Geeraerts T., et al. “Non-invasive assessment of intracranial pressure using ocular sonography in neocritical care patients”. Intensive Care Medicine 34.11 (2008): 2062-2067.
  26. Moretti R and Pizzi B. “Optic nerve ultrasound for detection of intracranial hypertension in intracranial hemorrhage patients: confirmation of previous findings in a different patient population”. Journal of Neurosurgical Anesthesiology 21.1 (2009): 16-20.
Citation: Aldo Saad Diab., et al. “Optic Nerve Sheath Diameter in Retrobulbar Ultrasound as a Surrogate Measure for Intracranial Pressure Before and After Non-Invasive Strategies”. EC Emergency Medicine and Critical Care 4.7 (2020): 01-09.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

October Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the October issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before November 01, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to