Ocular Auscultation: A Review

  • Daniel Fernando Gallego Intern, Human Biology Division, Fred Hutchinson Cancer Research Center, USA.
  • Ana Maria Rivas-Grajales Graduate Student, Institute of Cognitive Neuroscience, University College of London, UK.
  • Carlos Jose Gallego Acting instructor, Division of Medical Genetics, University of Washington, USA.
Keywords: Auscultation, Physical Examination, Carotid Stenosis, Carotid-Cavernous, Sinus Fistula, Neurological Examination


Ocular auscultation is a commonly neglected step of routine physical examination. An adequate ocular auscultation can be helpful in discovering an ocular bruit, which is an important diagnostic finding for a broad spectrum of pathologic conditions, some of which are potentially fatal. In this article, we present a literature review on the physical exam maneuver of ocular auscultation, as well as the pathophysiology and differential diagnosis of ocular bruits. We also included a description of the adequate auscultation technique and a discussion about the applicability of ocular auscultation in clinical practice

Author Biography

Daniel Fernando Gallego, Intern, Human Biology Division, Fred Hutchinson Cancer Research Center, USA.

Daniel Fernando Gallego is an intern at the Human Biology Division of the Fred Hutch Cancer Research Center in Seattle, Washington, United States.

Ana María Rivas-Grajales is a Graduate Student, Institute of Cognitive Neuros¬cience, University College of London, UK.


1. Wadia NH, Monckton G. Intracranial bruits in health and disease. Brain. 1957 Dec;80(4):492-509.
2. Kurtz KJ. Bruits and hums of the head and neck. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory exa¬minations. 3rd ed. Boston: Butterworths; 1990.
3. Fisher CM. Cranial bruit associated with occlusion of the internal carotid artery. Neurology. 1957 May;7(5):299-306.
4. Jura E, Gołabek R, Kruszewska J, Kryst-Widźgowska T, Trzebicki J. [Giant ar¬teriovenous angiomas of the brain with scant clinical manifestations]. Neurol Neurochir Pol. 1991 Jan-Feb;25(1):107-13.
5. Smith JH, Fugate JE, Claassen DO. Pearls & oy-sters: the orbital bruit: a poor man’s angiogram. Neurology. 2009 Oct 20;73(16):e81-2.
6. Purcell JJ Jr. The effect of unsuspected carotid-cavernous fistula in enuclea¬tion. Am J Ophthalmol. 1979 Nov;88(5):946-8.
7. Brodsky LP. Auscultation of the human eye as a potential diagnostic aid. J Am Optom Assoc. 1980 Nov;51(11):1031-2.
8. Pessin MS, Panis W, Prager RJ, Millan VG, Scott RM. Auscultation of cervical and ocular bruits in extracranial carotid occlusive disease: a clinical and angiographic study. Stroke. 1983 Mar-Apr;14(2):246-9.
9. Hu HH, Liao KK, Wong WJ, Teng MM, Lo YK, Chu FL, et al. Ocular bruits in ischemic cerebrovascular disease. Stroke. 1988 Oct;19(10):1229-33.
10. Nisbet RM, Barber JC, Steinkuller PG. Doppler ultrasonic flow detector: an adjunct in evaluation of orbital lesions. J Pediatr Ophthalmol Strabismus. 1980 Jul-Aug;17(4):268-71.
11. Stokke TM, Ruddox V, Sarvari SI, Otterstad JE, Aune E, Edvardsen T. Brief group training of medical students in focused cardiac ultrasound may im¬prove diagnostic accuracy of physical examination. J Am Soc Echocardiogr. 2014 Nov;27(11):1238-46.
12. Biousse V, Mendicino ME, Simon DJ, Newman NJ. The ophthalmology of intracranial vascular abnormalities. Am J Ophthalmol. 1998 Apr;125(4):527-44.
13. Poppen JL. Cranial bruit; its significance. Surg Clin North Am. 1955 Jun;Lahey Clinic No.:881-6.
14. Tiefert JW. Orbital auscultation. Am Fam Physician. 1978 Dec;18(6):117-20.
15. Ellis JA, Goldstein H, Connolly ES Jr, Meyers PM. Carotid-cavernous fistu¬las. Neurosurg Focus. 2012 May;32(5):E9.
16. Kato M, Ikegame Y, Toyoda I, Ogura S, Kitajima H, Yoshimura S, et al. He¬mispheric
laminar necrosis as a complication of traumatic carotid-cavernous sinus fistula. Neurol Med Chir (Tokyo). 2009 Jan;49(1):26-9.
17. Ali S, Khan MA, Khealani B. Limb-shaking transient ischemic attacks: case report and review of literature. BMC Neurol. 2006;6:5.
18. Hirose Y, Yanagi T, Ito Y, Yasuda T. [Clinical significance of carotid and ocular bruits in cerebrovascular disease]. Rinsho Shinkeigaku. 1992 Oct;32(10):1081-6.
19. Gautier JC, Rosa A, Lhermitte F. [Carotid auscultation. Correlation in 200 patients with 332 angiograms]. Rev Neurol (Paris). 1975 Mar;131(3):175-84.
20. Ebihara A, Ashida T, Sugiyama T, Okuno S, Fujii J, Yonemitsu T. [An elderly hypertensive patient with ocular bruits and angiographically confirmed ste¬nosis of intracranical internal carotid arteries]. Nihon Ronen Igakkai Zasshi. 2002 Jan;39(1):94-6.
21. Lauritzen M, Alving J, Paulson OB. Orbital bruits and retinal artery pressu¬re in internal carotid artery occlusion. Clin Neurol Neurosurg. 1981;83(1):7-10.
22. Countee RW, Gnanadev A, Chavis P. Dilated episcleral arteries--a signifi¬cant physical finding in assessment of patients with cerebrovascular insuffi¬ciency. Stroke. 1978 Jan-Feb;9(1):42-5.
23. Gilbert GJ. Physical diagnosis of temporal arteritis. Eye Ear Nose Throat Mon. 1971 Dec;50(12):476-8.
24. Gilbert GJ. Eyeball bruits in temporal arteritis. Dis Nerv Syst. 1970 Feb;31(2):130-2.
25. Jazayeri F, Pearson A. Orbital bruit in Churg-Strauss orbitopathy; a novel sign. Orbit. 2012 Apr;31(2):65-6.
26. Wales RT, Martin EA. Arterial bruits in anemia. Br Med J. 1963 Dec 7;2(5370):1444-7.
27. Parry DH, Worwood M, Jacobs A. Letter: Increased serum iron in acute leukaemia. Br Med J. 1975 Aug 9;3(5979):372.
28. Nugent JS, O’Brien KE, Harris M, Mohan C. Paget’s disease of bone in an Indian patient: genetic and environmental factors. J Clin Rheumatol. 2002 Aug;8(4):212-6.
29. National Institute of Health. A classification and outline of cerebrovascu¬lar diseases. II. Stroke. 1975 Sep-Oct;6(5):564-616.
30. Atta HR, Dick AD, Hamed LM, Byrne SF, Gendron EK, Hughes RL, et al. Venous stasis orbitopathy: a clinical and echographic study. Br J Ophthalmol. 1996 Feb;80(2):129-34.
How to Cite
Fernando Gallego, D., Rivas-Grajales, A. M., & Jose Gallego, C. (2015). Ocular Auscultation: A Review. International Journal of Medical Students, 3(2), 102-106. https://doi.org/10.5195/ijms.2015.125