{"id":2329,"date":"2024-11-28T18:00:00","date_gmt":"2024-11-28T18:00:00","guid":{"rendered":"https:\/\/emultrasound.sdsc.edu\/?p=2329"},"modified":"2024-11-11T23:38:34","modified_gmt":"2024-11-11T23:38:34","slug":"case-38-painless-worsening-vision","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2024\/11\/28\/case-38-painless-worsening-vision\/","title":{"rendered":"Case 38: Painless Worsening Vision"},"content":{"rendered":"\n

Liz Volochyna-Farber<\/h2>\n\n\n\n

A 37-year-old male with a past medical history of retinal detachment (RD) of the left eye (OS), left eye cataract surgery and retinal tear in the rigth eye (OD) s\/p laser presents to Emergency Department (ED) on a Sunday with painless worsening right eye vision. It started with a floater in the eye 2 days prior. The patient went to an outside ED, has been given a diagnosis and was told to see ophthalmology, but was unable to do that over the weekend. Meanwhile his symptoms worsened, so he came to our ED. He endorsed mild itching to the eye but denied trauma, pain, foreign body sensation, fever and neurologic changes.<\/p>\n\n\n\n

Eye exam: PERRL, EOMI, no injection\/discharge, no nystagmus, no corneal abrasion or fluorescein uptake b\/l, left superior field defect present OD<\/strong>, visual acuity OD 20\/400<\/strong> pinhole corrected to 20\/40<\/strong>, OS 20\/20-2, IOP L13, R13<\/p>\n\n\n\n

An ocular ultrasound is performed and the images below are seen. What do you see, and what is his most likely diagnosis? What is your management?<\/p>\n\n\n\n

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Figure 1: Right eye.<\/p>\n\n\n\n

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Figure 2: Right eye kinetic scan. Retinal detachment (arrows) is demonstrated by a bright, echogenic membrane tethered to the optic disc (star) in image B. The optic nerve and disk can be seen in the lower right corner of image A, while in image B, the disk is positioned more medially, with tethering observed, though the retina is detached to the left of the optic disc.<\/p>\n\n\n\n

Ophthalmology was consulted at the bedside. On a dilated fundoscopic exam of the right eye, a mac-off retinal detachment (RD) was noted temporally between 6:00 and 10:30, extending onto the temporal macula next to the fovea, with a hole at the 8:00 position, likely the causative break. Surgery was recommended within the next few days. Records from an outside emergency department were not obtained, but it is possible that the patient initially presented with a mac-on RD, and if treated immediately, could have had a better prognosis.<\/p>\n\n\n\n

Learning points<\/strong><\/p>\n\n\n\n