Written by Dr. Chris Hanuscin
Edited by Dr. Nicole Anthony
Case Presentation
A middle-aged female presents to the ED with 3 days of intermittent floaters and “curtain-like”, painless loss of vision. She denies any history of trauma.
A bedside ultrasound shows the following finding:
This is consistent with posterior vitreous detachment.
Ophthalmology agreed with the ED diagnosis.
Contrast posterior vitreous detachment with the following examples of other ocular pathologies from The Pocus Atlas:
Vitreous Hemorrhage
Note the swirling “washing machine effect.”
Posterior Vitreous Detachment
Posterior vitreous detachment will appear like a hyperechoic “flap” floating in the posterior chamber.
Retinal Detachment
Retinal detachment will also appear like a hyperechoic flap, but unlike vitreous detachment, the flap will appear to be tethered to the optic disk.
Ocular ultrasound is fast and simple and can be useful in identifying ocular pathology, particularly if the physical exam is limited. Ocular ultrasound can also help distinguish true ocular emergencies as patients can present with similar complaints (i.e. retinal detachment versus posterior vitreous detachment ). Remember to place a transparent film dressing (such as Tegaderm®) over the patient’s closed eyelid, use lots of gel, and apply very little pressure with the linear probe.
Resources
A step-by-step guide on how to perform and interpret ocular ultrasound.
Special thanks to Drs. Garcia, Chao, and Hanuscin for the case and images.
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