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Updated: May 9, 2026

Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition
06:09

Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition

Published on: August 18, 2023

Ultrasonographic optic nerve sheath diameter for predicting elevated intracranial pressure and clinical severity in

Md Naseem1, Varun Anand2, Rishika Das3

  • 1Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. md_naseem@msn.com.

European Journal of Pediatrics
|May 8, 2026
PubMed

Insights

Point-of-care ultrasound (POCUS) effectively detects elevated intracranial pressure (ICP) in children by measuring optic nerve sheath diameter (ONSD). While ONSD indicates raised ICP, it doesn't correlate with clinical severity, but POCUS remains a valuable diagnostic tool.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Medical Imaging

Background:

  • Elevated intracranial pressure (ICP) is a critical concern in pediatric neurological conditions, potentially leading to fatal brainstem herniation.
  • Optic nerve sheath diameter (ONSD) is a validated noninvasive marker for detecting intracranial hypertension in children.
  • Current limitations exist as ONSD does not correlate with the clinical severity of ICP, restricting its use in quantitative stratification.

Purpose of the Study:

  • To evaluate point-of-care ultrasound (POCUS) for noninvasive detection of elevated ICP in children under 14 years.
  • To determine optic nerve sheath diameter (ONSD) values via POCUS and correlate them with ICP clinical severity.
  • To establish age-specific ONSD values for ICP diagnosis and prediction, determine normal values, and assess ONSD changes with hyperosmolar therapy.

Main Methods:

  • Prospective observational study over 18 months involving children under 14 years.
  • Measurement of optic nerve sheath diameter (ONSD) using point-of-care ultrasound (POCUS).
  • Comparison of ONSD values between children with and without elevated ICP, including age-matched controls and assessment of response to hyperosmolar therapy.

Main Results:

  • Children with raised ICP showed significantly larger ONSD (5.63 mm) compared to controls (4.35 mm).
  • ONSD measurements were consistent across different anatomical locations.
  • Age influenced ONSD in healthy children but not in those with raised ICP; age-specific cut-offs demonstrated high sensitivity and specificity.
  • Both hypertonic saline and mannitol effectively reduced ONSD, indicating comparable efficacy.

Conclusions:

  • POCUS-measured ONSD is a reliable tool for detecting elevated ICP in pediatric patients.
  • Further research is necessary to refine age-specific ONSD norms and improve ICP severity prediction.
  • ONSD measurement via POCUS shows significant promise as an adjunct in managing pediatric ICP.

Keywords:
Diagnostic accuracyHyperosmolar therapyIntracranial hypertensionOptic nerve sheath diameterPediatricsPoint-of-care ultrasound

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