• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Toxicology
    • Trauma
    • Ultrasound
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us

Macula-Off Retinal Detachment Identified on Bedside Ultrasound

Colin Prather, MD* and Bryson Hicks, MD*

*Oregon Health & Sciences University, Department of Emergency Medicine, Portland, OR

Correspondence should be addressed to Colin Prather, MD at ecprather@gmail.com

DOI: https://doi.org/10.21980/J8WP8KIssue 4:2
OphthalmologyVisual EM
No ratings yet.

History of present illness:

A previously healthy 53-year-old male presented with complaints of right-sided vision loss, which he described as a “curtain being drawn” across his vision from medial to lateral. There was no preceding trauma, no pain in the eye, and the patient denied seeing flashers or floaters. Visual acuity was intact only to light perception, with the rest of the external ocular exam unremarkable.

Significant findings:

Point-of-care ultrasound was performed, demonstratinga free-floating, serpiginous, hyperechoic membrane (R) tethered at the optic nerve (ON) and ora serrata (OS), but detached at the macula (M) lateral to the optic nerve. This is diagnostic for macula-off retinal detachment. It can be differentiated from macula-on retinal detachment, in which the hyperechoic retina would appear attached posteriorly at the location of the macula just lateral to the optic nerve. Ophthalmology was consulted, agreed with the diagnosis of macula-off retinal detachment, and took the patient to the OR for laser photocoagulation.

Discussion:

The bedside ocular ultrasound exam is easily taught and performed, and can help guide clinical decision-making for patients with visual disturbances.1 For patients who present to the emergency department with ocular complaints such as vision loss or eye pain, it can help identify conditions that require emergent ophthalmologic consultation or transfer to a hospital with access to ophthalmology This can be particularly helpful for patients in whom direct fundoscopy does not provide a definitive diagnosis.

Multiple studies have demonstrated good sensitivity and specificity for accurately identifying retinal detachments with point of care ultrasound using a linear array probe.2,3 However, challenges in diagnosis arise when differentiating retinal detachment from posterior vitreous detachment and vitreous hemorrhage.Detachment of the vitreous membrane also appears as a thin hyperechoic membrane in the posterior vitreous chamber, but can be differentiated from retinal detachment that has a thicker more hyperechoic appearance. Detection of vitreous detachment often requires increasing the gain setting to visualize. The retina also attaches the optic nerve, whereas the vitreous membrane does not. Correct differentiation of retinal detachment from vitreous detachment and other ocular pathologies can guide the need for emergent ophthalmology consultation for macula-on retinal detachment, versus close outpatient follow up for vitreous detachment or macula-off retinal detachment.1,4-8

Topics:

Macula off, retinal detachment, point-of-care ultrasound.

References:

  1. Baker N, Amini R, Situ-LaCasse E, Acuna J, Nuno T, Stolz U, et al. Can emergency physicians accurately distinguish retinal detachment from posterior vitreous detachment with point-of-care ocular ultrasound? Am J Emerg Med. 2018;36(5):774-776. doi: 10.1016/j.ajem.2017.10.010
  2. Shiner Z, Chan L, Orlinsky M. Use of ocular ultrasound for the evaluation of retinal detachment. J Emerg Med. 2011;40(1):53-57. doi: 10.1016/j.jemermed.2009.06.001
  3. Jacobsen B, Lahham S, Lahham S, Patel A, Spann S, Fox JC. Retrospective review of ocular point-of-care ultrasound for detection of retinal detachment. West J Emerg Med. 2016;17(2):196-200. doi: 10.5811/westjem.2015.12.28711
  4. Lyon M, Von Kuenssberg Jenle D. Ocular. In: Ma OJ, Mateer JR, Reardon RF, Join SA. Ma and Mateer’s Emergency Ultrasound. New York, NY: McGraw-Hill. 2008:569-586.
  5. Kahn A, Kahn,AL, Corinaldi CA, Benitez FL, Fox PC. Retinal detachment diagnosed by bedside ultrasound in the emergency department. Cal J Emerg Med. 2005;1(3):47-51.
  6. Woo M, Hect N, Hurley B, Stitt D, Thiruganasambandamoorthy, V. Test characteristics of point-of-care ultrasonography for the diagnosis of acute posterior ocular pathology. Can J Ophthalmol. 2016;51(5):336-341. doi: 10.1016/j.jcjo.2016.03.020
  7. De La Hoz Polo M, Torramilans Lluis A, Pozuelo Segura O, Anguera Bosque A. Esmerado Appiani, Caminal Mitjana J. Ocular ultrasonography focused on the posterior eye segment: what radiologists should know. Insights Imaging. 2016;7(3):351-364. doi: 10.1007/s13244-016-0471-z
  8. Schott M, Pierog J, Williams S. Pitfalls in the Use of Ocular Ultrasound for Evaluation of Acute Vision Loss. J Emerg Med. 2013;44(6):1136-1139. doi: 10.1016/j.jemermed.2012.11.079
Icon

Macula-Off Retinal Detachment Ultrasound - Case Report

1 file(s) 571 KB
Download
Icon

Macula-Off Retinal Detachment Ultrasound - Supplemental File

1 file(s) 2.1 MB
Download
Issue 4:2Ultrasound

Reviews:

No ratings yet.

Please rate this





Point-of-Care Ultrasound for the Diagnosis of...

29 Dec, 18

Posterior Vitreous Detachment

29 Dec, 18
JETem is an online, open access, peer-reviewed journal-repository for EM educators

Most Viewed

  • Telemedicine Consult for Shortness of Breath Due to Sympathetic Crashing Acute Pulmonary Edema
  • Anticholinergic Toxicity in the Emergency Department
  • The Suicidal Patient in the Emergency Department Team-Based Learning Activity
  • Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic
  • Acute Chest Syndrome

Visit Our Collaborators

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright © 2016 JETem. All rights reserved.