BACKGROUND: Elevated intracranial pressure (eICP) is a medical emergency that may present as a result of mass lesions, traumatic bleeds, brain oedema, or in some cases, of idiopathic nature. Identification of the life threatening condition is difficult with patients having vague symptoms of headache, nausea, visual disturbances, or decreased level of consciousness. The current gold standards for the detection and monitoring of eICP are invasive and increase the patient’s risk of infection and complications. Since the cerebral meninges are continuous with the optic nerve sheath (ONS) - Ocular ultrasound has emerged as a rapid, non-invasive, bedside tool to measure the ONS diameter as a correlate of eICP. This systematic review seeks to explore the utility of ultrasound detected elevated optic disc height (ODH) as another easily obtained ultrasonographic finding of eICP - and to study its sensitivity and specificity as a marker of eICP.

METHODS: This systematic review followed the preferred reporting items for systematic reviews and meta-analyses guidelines. We preliminarily identified 24 english articles, from three different databases, that correlated ultrasonographically detected optic disc height elevation with cerebral or ocular pathology in humans. 

RESULTS: 24 articles with a sum of 891 patients were included in this preliminary study. In patients with papilledema, the mean ODH ranged between 0.8 mm and 1.17 mm - with slight variation reported between left and right eyes in some studies. ODH had variable sensitivity and specificity in detecting papilledema. Proposed cutoff values for ODH included 0.4 mm, 0.6 mm, or 1 mm. The lowest sensitivity reported was 18.75%, but the majority of studies reported a sensitivity between 82% and 95%.Specificity ranged from 71% to 100%.

CONCLUSIONS: ONH and ultrasonographic characteristics of the optic disc can aid in differentiating papilledema and pseudopapilledema - and thereby serve as a correlate of eICP.