Ophthalmology

Bedside Ultrasound of Retinal Detachment in a 19-year-old

Rami San Gabriel, BS^*, Maili Alvarado, MD^* and Vy Han, MD^*

DOI: https://doi.org/10.21980/J80W6TIssue 3:3[mrp_rating_result]

The ocular point of care ultrasound (POCUS) utilizing a high frequency linear probe shows a retinal detachment (RD) with a thick, hyperechoic undulating membrane in the vitreous humor that is anchored at the ora serrata anteriorly and the optic disc posteriorly. Note that the retina is detached all the way to the optic disc making it "mac off." The macula, and more specifically the fovea, is located in the central retina and contains a high concentration of cone photoreceptors responsible for central, high resolution, color vision. In a "mac on" RD, the retina detaches in the periphery but remains intact centrally. This is an ophthalmologic emergency and timely diagnosis and intervention can be vision saving. This patient also has evidence of a posterior vitreous hemorrhage which has a characteristic swirling appearance with kinetic exam on real-time imaging. The detached vitreous body is not as well defined and is not anchored posteriorly to the optic disc.

Ophthalmology Visual EM

Traumatic Hyphema

James Roy Waymack, MD^* and Mark Baker, MD^*

DOI: https://doi.org/10.21980/J8Z04SIssue 3:3[mrp_rating_result]

Upon initial evaluation, the patient had an obvious hyphema in the right eye with associated conjunctival injection. Initially, the bleeding in the anterior chamber was cloudy just above the level of the pupil (yellow arrow), appearing to possibly be a grade II hyphema. There were no other signs of trauma to the eye under Wood’s lamp examination with fluorescein staining. The globe was intact. Intraocular pressure in the affected eye was 19 mmHg and 15 mmHg in the unaffected eye. Extraocular movements were full and intact. The pupil was 4 mm round and reactive to direct and consensual light. Visual acuity was greater than 20/200 in the affected eye compared to 20/25 in the unaffected eye. After an observation period of two hours, with the patient remaining upright, the hyphema had settled down to a rim in the lower anterior chamber (green arrow), a grade I hyphema.

Ophthalmology Visual EM

Retinal Detachment

Adnan Riaz, MD^*, Chirag Shah, MD^* and Grant Wei, MD^*

DOI: https://doi.org/10.21980/J8204QIssue 3:2[mrp_rating_result]

Bedside ocular ultrasound revealed a serpentine, hyperechoic membrane that appeared tethered to the optic disc posteriorly with hyperechoic material underneath. These findings are consistent with retinal detachment (RD) and associated retinal hemorrhage.

Ophthalmology Ultrasound Visual EM

Herpes Zoster Ophthalmicus

Shayna Adams, BS^* and Darren Knight, MD^{^}

DOI: https://doi.org/10.21980/J88H07 Issue 3:2[mrp_rating_result]

Physical exam was significant for an erythematous maculopapular rash in the right ophthalmic nerve (V1) region, a crusted vesicle at the right upper eyelid, and surrounding eyelid edema. Visual acuity remained at baseline and intraocular pressure was within normal limits. External slit lamp exam with fluorescein staining was remarkable for pseudodendrites in the inferior-temporal cornea approximately 1.5 mm from the limbus. Ophthalmology was consulted and completed an in-depth evaluation of the corneal lesions. They found no evidence of anterior chamber reaction and performed a complete dilated fundus examination which demonstrated no retinal involvement. The patient was then discharged on acyclovir and erythromycin ointment with close follow-up.

Ophthalmology Visual EM

Point-of-care Ultrasound Detection of Endophthalmitis

James Tucker MD, PhD^*, Jonathan Patane, MD^{^} and Shadi Lahham, MD, MS^{^}

DOI: https://doi.org/10.21980/J8G634 Issue 3:1[mrp_rating_result]

The patient’s ultrasound revealed an attached retina and a complex network of hyperechoic, mobile, membranous material in the posterior segment.

Ophthalmology Ultrasound Visual EM

Corneal Sparing Conjunctival Abrasion

Hamid Ehsani-Nia, MS^*, Tanya Dall, MD^{^} and Samantha Costantini, MD^{^}

DOI: https://doi.org/10.21980/J8KG93 Issue 2:3[mrp_rating_result]

Physical exam was significant for multiple broken teeth, multiple minor abrasions on the face, and fine shards of shattered glass on his face and hair. His right eye had conjunctival injection, with no signs of subconjunctival hemorrhage or ocular penetration. Vision, extraocular movement, and pupillary exam were grossly intact. Fluorescein staining with slit lamp exam with cobalt blue filter examination of the right eye revealed superficial bulbar conjunctival uptake of fluorescein dye staining an area of the conjunctiva inferior to the limbus 5 mm vertical by 2 mm horizontal (estimation by photo provided). No foreign bodies were visualized in the inferior fornix. These findings were consistent with superficial conjunctival abrasion. The exam noted sparing of the corneal epithelium.

Ophthalmology Visual EM

Globe Rupture

Reid Honda, MD^*

DOI: https://doi.org/10.21980/J8N91Z Issue 2:3[mrp_rating_result]

The patient’s computed tomography (CT) head demonstrated a deformed left globe, concerning for ruptured globe. The patient had hyperdense material in the posterior segment (see green arrow), consistent with vitreous hemorrhage. CT findings that are consistent with globe rupture may include a collapsed globe, intraocular air, or foreign bodies.

Ophthalmology Visual EM