We used high-frequency ultrasound B-scanning with digital signal processing for pachymetric analysis of corneal scars to help determine the optimal management strategy. Four patients were selected for this report. By an automated motor system, 12 consecutive, parallel ultrasound B-scans, each 2.5 to 3 mm wide at 0.25 mm intervals, were obtained from the central corneal area of three patients with anterior corneal scarring. In a fourth patient with near complete corneal scarring obscuring the view of the anterior chamber, a set of 15 mm wide B-scans was obtained. Digitized ultrasound signals were used to produce high-resolution images and I-scans enabling a pachymetric precision of +/- 2 microns (SD). Epithelial, scar, and corneal thickness measurements were made along each scan to determine the most significant zone of pathology. Pachymetry of the cornea and the individual layers was used to assess the suitability for either photorefractive or penetrating keratectomy. B-scan imaging of the full anterior segment provided useful information for the preoperative planning of anterior segment reconstruction and the prognostic evaluation of penetrating keratoplasty. This method provides a powerful tool for the corneal surgeon in management planning.