Contact Ultrasonography and Hypotonous Eyes

To the Editor. —We read with interest the case report by Dannemann et al 1 in the July 1989 issue of theArchives. The authors reported an interesting dramatic event during ultrasonography and concluded from this one event that "ultrasonography should be limited to those cases where funduscopic evaluation is impossible but necessary for clinical management." This conclusion is unwarranted and overstated. The primary variable in this patient was the hypotony. For other patients, contributory factors include vomiting, coughing, and inadvertent Valsalva maneuvers. Ultrasonography is helpful in separating serous choroidals from hemorrhagic choroidals; when the latter are kissing, drainage often accelerates improvement. Careful ultrasonography should not be withheld from the management of these