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Image of the Fortnight

These images are courtesy of Dr. Jasmin Tanaja, and Dr. Layne Madden, two upper level EM residents working at Emory University Hospital Emergency Department recently who took care of 2 patients with ocular complaints. The first patient was a previously healthy elderly gentleman who presented to hospital reporting unilateral, central vision loss and floaters for a week. Vitals signs and 10-point ROS were otherwise normal.  Bedside ultrasound is copied below:

Retinal detachment

Compare this image with another ocular ultrasound performed in the ED that week in a middle-aged woman who presented with 2 days of floaters and unilateral, central vision loss. She too had normal vital signs and normal external ocular exam.

Vitreous detachment

These were similar clinical presentations, but in the first ultrasound, there is a mobile flap just anterior to the retina that is tethered to the optic nerve posteriorly and ora serrata anteriorly [arrows]. This is typical of a retinal detachment. The second video demonstrates a vitreous detachment, where an undulating membrane is seen beyond the limits of the optic nerve, and that continues to move after eye movement has stopped.

Ultrasound is a great tool to distinguish the two, especially because retinal detachment requires immediate ophthalmologic referral to prevent permanent vision loss. Patients with vitreous detachment also require close follow-up with ophthalmology, but less urgency than retinal detachment.  It is important to sweep through the globe in 2 planes thoroughly to avoid misidentifying a retinal detachment for a vitreous detachment - if in doubt, err on the more conservative side, and request urgent ophthalmology consult.

Happy scanning!

Tricia Smith, M.D.

Emory Ultrasound Fellow