A 63 year old male presents for “floaters” in his right eye for two weeks. He wears reading glasses at baseline. He denies pain or known injury to the eye. On exam, his visual acuity is 20/30 OD, 20/20 OS corrected with reading glasses. Pupils are equal, round, and reactive to light. IOP is 8 OD, 9 OS. There are no areas of focal uptake with fluorescein stain. POCUS of the right orbit is shown below. What’s the diagnosis?
Answer: Posterior Vitreous Detachment and Vitreous Hemorrhage (bright echogenic membrane horizontally across the posterior chamber not attached at the optic nerve and multiple free-flowing areas of varying hyperechogenicity that are mobile with eye movement)
- Presentation may vary from sudden onset floaters and generalized hazy vision to complete vision loss depending on severity
- May sometimes be a precursor to a retinal detachment
- Important to distinguish from a retinal detachment which will demonstrate a “V” shaped echogenic membrane attached to the optic nerve on POCUS
- Management is ophthalmology consultation especially if retinal detachment is suspected as it is a true ophthalmologic emergency
References:
Walker R.A., & Adhikari S (2020). Eye emergencies. Tintinalli J.E., & Ma O, & Yealy D.M., & Meckler G.D., & Stapczynski J, & Cline D.M., & Thomas S.H.(Eds.), Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill.
Lahham, S., Ali, Q., Palileo, B. M., Lee, C., & Fox, J. C. (2019). Role Of Point Of Care Ultrasound In The Diagnosis Of Retinal Detachment In The Emergency Department. Open access emergency medicine : OAEM, 11, 265–270. https://doi.org/10.2147/OAEM.S219333
www.emra.org/emresident/article/floaters-retinal-detachment-posterior-vitreous-detachment-or-vitreous-hemorrhage
