Utilizing transorbital ultrasound for assessment of intracranial pressure in traumatic brain injury patients

Abstract Background Elevated intracranial pressure (ICP) is a major determinant of morbidity and mortality in traumatic brain injury (TBI). While invasive monitoring remains the reference standard, it is not universally available and carries procedural risks. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) has emerged as a promising noninvasive surrogate marker of ICP. This prospective study evaluated the association between ONSD and neurological status in adult patients with TBI. Methods Fifty adult patients with acute TBI were prospectively enrolled at a single tertiary neurosurgical center. Admission Glasgow Coma Scale (GCS), computed tomography findings, and transorbital ONSD measurements were recorded. Correlation between ONSD and GCS was analysed using Pearson’s correlation coefficient. In a predefined surgical subgroup ( n = 10) undergoing hematoma evacuation, repeat ONSD and GCS assessments were performed at 72 h to evaluate dynamic changes. Statistical significance was set at p < 0.05. Results Mean admission GCS was 12.9 ± 3.25, and mean bilateral ONSD was 5.21 ± 0.62 mm. A strong negative correlation was observed between ONSD and GCS ( r = -0.729, p < 0.001), indicating higher ONSD values in patients with greater neurological impairment. In the surgical subgroup, GCS improved significantly from 12.4 ± 0.52 to 14.3 ± 0.48 at 72 h ( p < 0.001), accompanied by significant reductions in right-eye, left-eye, and mean bilateral ONSD values (all p < 0.001). Overall mortality was 8%. Conclusions ONSD measured by bedside ultrasonography correlates inversely with neurological status and demonstrates responsiveness to therapeutic intervention in adult TBI. These findings support its potential role as a practical, noninvasive adjunct to clinical neurological assessment.