{"id":2583,"date":"2026-03-31T17:52:34","date_gmt":"2026-03-31T17:52:34","guid":{"rendered":"https:\/\/emultrasound.ucsd.edu\/?p=2583"},"modified":"2026-03-31T17:52:37","modified_gmt":"2026-03-31T17:52:37","slug":"case-64-ocular-emergencies-a-case-of-macula-on-retinal-detachment-seen-on-pocus","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2026\/03\/31\/case-64-ocular-emergencies-a-case-of-macula-on-retinal-detachment-seen-on-pocus\/","title":{"rendered":"Case 64: Ocular emergencies: A case of macula-on retinal detachment\u00a0seen\u00a0on POCUS\u202f\u00a0"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Theresa Jo Thomas\u202f,\u00a0Akash Desai<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Case: A&nbsp;49-year-old&nbsp;female with a past medical history of type 1 diabetes on insulin and myopia&nbsp;presented to the emergency department&nbsp;for vision changes.&nbsp;The patient&nbsp;stated&nbsp;that three days ago she&nbsp;noticed&nbsp;\u201cflashers\u201d in&nbsp;the&nbsp;vision of her right&nbsp;eye&nbsp;which she described as \u201csquiggly lines\u201d.&nbsp;The patient&nbsp;stated&nbsp;that on the day of her presentation to the emergency department at 1100 she noticed the bottom half of her vision as \u201cgrayed out\u201d when looking to the ground.&nbsp;She&nbsp;stated&nbsp;that the grey vision was not present when looking upwards.&nbsp;The patient denied trauma to the eye, recent illness,&nbsp;eye&nbsp;pain, or eye&nbsp;irritation.\u202f\u202f&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Vitals<\/strong>\u202f: BP 129\/87 HR 99 RR 17 SpO2 100% T 97.2 F\u202f\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Physical\u00a0Exam:<\/strong>\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>HEENT<\/em>: Bilateral pupils\u00a0equal, round,\u00a0and reactive\u00a0to light.\u00a0Bilateral\u00a0eyes\u00a0without conjunctival injection, no\u00a0hyphema\u00a0or hypopyon. No pain with\u00a0extraocular movements\u00a0and\u00a0extraocular movements\u00a0intact. No notable trauma to orbit, no orbital bruising or tenderness.\u202f\u202f\u00a0 Visual acuity was measured as below:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>OD 20\/50\u202fUncorrected&nbsp;<\/li>\n\n\n\n<li>OS&nbsp;20\/25&nbsp;Uncorrected&nbsp;<\/li>\n\n\n\n<li>OU 20\/50 Uncorrected&nbsp;<\/li>\n\n\n\n<li>OD 20\/50 Corrected&nbsp;<\/li>\n\n\n\n<li>OS 20\/30 Corrected&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Given patient\u2019s concerning presentation, a bedside ocular ultrasound was performed to help further differentiate the patient\u2019s complaint.&nbsp;<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"508\" height=\"619\" src=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2026\/03\/image-1.png?resize=508%2C619&#038;ssl=1\" alt=\"\" class=\"wp-image-2584\" srcset=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2026\/03\/image-1.png?w=508&amp;ssl=1 508w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2026\/03\/image-1.png?resize=246%2C300&amp;ssl=1 246w\" sizes=\"auto, (max-width: 508px) 100vw, 508px\" \/><figcaption class=\"wp-element-caption\"><strong>Figure 1.<\/strong>\u00a0Ocular ultrasound.\u00a0Detached retinal membrane (R).\u00a0The membrane is shown to be attached\u00a0at\u00a0the macula (M), lateral to the optic nerve\u00a0(ON) which can be\u00a0identified\u00a0due to its characteristic\u00a0nerve sheath\u00a0shadow in the far field of the\u00a0image.\u00a0\u00a0<\/figcaption><\/figure>\n<\/div>\n\n\n<figure class=\"wp-block-video\"><video height=\"1080\" style=\"aspect-ratio: 1920 \/ 1080;\" width=\"1920\" controls src=\"https:\/\/emultrasound.ucsd.edu\/wp-content\/uploads\/2026\/03\/RD-video.mov\"><\/video><figcaption class=\"wp-element-caption\"><strong>Figure 2.\u00a0<\/strong>Ocular ultrasound clip with evidence of retinal detachment with macula-on. Ultrasound performed with linear array\u00a0transducer\u00a0in the longitudinal plane. The detached\u00a0hyperechoic,\u00a0serpiginous membrane, in a vertical orientation,\u00a0seen on the left side of the image in the posterior\u00a0chamber\u00a0is indicative of a retinal detachment.\u00a0Notice\u00a0here that the detachment\u00a0edge\u00a0begins\u00a0lateral to\u00a0the macula.\u00a0Due to a temporary PACS connectivity issue at the time of scanning, the ultrasound images were documented via mobile device recording of the screen rather than direct export. This explains the presence of motion\u00a0artifact\u00a0and reduced image fidelity in the attached clip.\u00a0<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"525\" height=\"196\" src=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2026\/03\/image-2.png?resize=525%2C196&#038;ssl=1\" alt=\"\" class=\"wp-image-2586\" srcset=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2026\/03\/image-2.png?w=799&amp;ssl=1 799w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2026\/03\/image-2.png?resize=300%2C112&amp;ssl=1 300w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2026\/03\/image-2.png?resize=768%2C286&amp;ssl=1 768w\" sizes=\"auto, (max-width: 706px) 89vw, (max-width: 767px) 82vw, 740px\" \/><figcaption class=\"wp-element-caption\"><strong>Figure 3.\u00a0<\/strong>Differentiating between retinal detachment, posterior vitreous\u00a0detachment,\u00a0and vitreous hemorrhage with POCUS.\u00a0\u00a0Source: <a href=\"https:\/\/pocus101.b-cdn.net\/wp-content\/uploads\/2020\/08\/POCUS-101-Ocular-Ultrasound-Pocket-Card.pdf\">POCUS 101<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>ED Course<\/strong>\u202f&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ophthalmology was urgently consulted for concern for macula-on retinal detachment&nbsp;on bedside ultrasound. The patient was seen&nbsp;in the ED&nbsp;by&nbsp;ophthalmology&nbsp;who confirmed the diagnosis of macula-on retinal&nbsp;detachment,&nbsp;and&nbsp;the&nbsp;patient was scheduled for retinal surgery to occur&nbsp;later&nbsp;the same day.&nbsp;The patient was&nbsp;instructed to maintain NPO&nbsp;status and&nbsp;was discharged&nbsp;in hemodynamically stable condition&nbsp;to present to&nbsp;surgery as scheduled later that day.\u202f\u202f&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Discussion<\/strong>\u202f&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This case highlights the utility of&nbsp;POCUS&nbsp;in the diagnosis of retinal detachment.&nbsp;The&nbsp;presentation&nbsp;can vary, with patients often reporting an acute painless loss of vision or flashes&nbsp;and&nbsp;floaters [2].&nbsp;Additional&nbsp;differential diagnoses include&nbsp;vitreous hemorrhage and&nbsp;posterior&nbsp;vitreous detachment, both of which can be&nbsp;identified&nbsp;on ultrasound. Retinal detachment is an ophthalmological emergency,&nbsp;while vitreous hemorrhage and&nbsp;posterior vitreous&nbsp;detachment can&nbsp;typically&nbsp;be&nbsp;managed with urgent&nbsp;outpatient&nbsp;follow-up&nbsp;with ophthalmology [2]. Thus, the diagnosis of retinal detachment is a time-sensitive diagnosis. The diagnosis of retinal detachment is typically made with dilated direct and indirect&nbsp;fundoscopic&nbsp;exams.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When performing ocular&nbsp;ultrasound&nbsp;for this purpose, the linear array transducer should be used&nbsp;to obtain&nbsp;both transverse and longitudinal views of the eye. The patient should be instructed to move the eye superiorly&nbsp;and&nbsp;inferiorly&nbsp;as well as horizontally while examining with ultrasound [3].&nbsp;The finding of interest&nbsp;suggesting&nbsp;retinal detachment is the presence of a retinal flap [4].&nbsp;&nbsp;If the membrane flap&nbsp;is&nbsp;attached&nbsp;in&nbsp;the posterior&nbsp;globe&nbsp;and does not cross the&nbsp;optic nerve, this is&nbsp;suggestive&nbsp;of&nbsp;retinal detachment. This is typically a thicker, more hyperechoic&nbsp;flap than&nbsp;what&nbsp;is&nbsp;seen&nbsp;with a vitreous detachment [3].&nbsp;Vitreous detachments, on the other hand,&nbsp;can&nbsp;cross the midline and&nbsp;are not&nbsp;tethered to the optic disc [3]. Should the retinal detachment be visualized extending&nbsp;temporally&nbsp;from the base of the optic nerve, near the approximate location of the macula, it is suggestive of macula off retinal detachment [3].\u202f\u202fConversely,&nbsp;lack of visualization of a&nbsp;retinal flap&nbsp;in the area of&nbsp;the macula is suggestive of macula-on retinal detachment.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ocular POCUS has been shown to&nbsp;diagnose retinal detachment reliably and accurately&nbsp;in the emergency department [5]. The standard of care&nbsp;includes urgent&nbsp;ophthalmology consultation&nbsp;as this&nbsp;problem&nbsp;is&nbsp;typically surgically managed to maximize vision preservation.&nbsp;Of note, macula-on retinal detachments have far better visual prognosis than&nbsp;macula-off retinal detachments, highlighting the importance of&nbsp;POCUS in&nbsp;facilitating&nbsp;early detection and&nbsp;vision-saving&nbsp;intervention.&nbsp;&nbsp;Specifically, in macula-on cases,&nbsp;timely&nbsp;repair offers an opportunity to preserve central vision before permanent loss occurs, highlighting the value of ultrasound in distinguishing macula-on from macula-off detachments.&nbsp;It has been shown that emergency physicians can reliably exclude vitreous hemorrhage and detachment when performing POCUS to&nbsp;evaluate for&nbsp;retinal detachment [2].&nbsp;We&nbsp;demonstrate&nbsp;here a case of macula-on retinal detachment&nbsp;identified&nbsp;on POCUS by an emergency physician.&nbsp;\u202f\u202f&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u202f&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References\u202f<\/strong>&nbsp;<\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>POCUS 101. Ocular ultrasound pocket card [Internet]. POCUS 101; 2020 Aug [cited 2026 Jan 6]. Available from:\u00a0<a href=\"https:\/\/pocus101.b-cdn.net\/wp-content\/uploads\/2020\/08\/POCUS-101-Ocular-Ultrasound-Pocket-Card.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/pocus101.b-cdn.net\/wp-content\/uploads\/2020\/08\/POCUS-101-Ocular-Ultrasound-Pocket-Card.pdf<\/a>\u00a0<\/li>\n\n\n\n<li>Lahham S,\u00a0Shniter\u00a0I, Thompson M, Le D, Chadha T, Mailhot T, Kang TL, Chiem A,\u00a0Tseeng\u00a0S, Fox JC. Point-of-Care Ultrasonography in the Diagnosis of Retinal Detachment, Vitreous Hemorrhage, and Vitreous Detachment in the Emergency Department. JAMA\u00a0Netw\u00a0Open. 2019 Apr 5;2(4):e192162.\u00a0doi: 10.1001\/jamanetworkopen.2019.2162. PMID: 30977855; PMCID: PMC6481597.\u202f\u202f\u00a0<\/li>\n\n\n\n<li>Situ-LaCasse E, Adhikari SR. Ocular emergencies.\u00a0<em>Sonoguide\u00a0<\/em>[Internet].<em>\u00a0<\/em>American College of Emergency Physicians; 2020 Aug 18 [cited 2026 Jan 6]. Available from:\u00a0<a href=\"https:\/\/www.acep.org\/sonoguide\/advanced\/ocular-emergencies\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.acep.org\/sonoguide\/advanced\/ocular-emergencies<\/a>\u00a0<\/li>\n\n\n\n<li>Yoonessi\u00a0R, Hussain A, Jang TB. Bedside ocular ultrasound for the detection of retinal detachment in the emergency department.\u00a0Acad\u00a0Emerg Med. 2010 Sep;17(9):913-7.\u00a0doi: 10.1111\/j.1553-2712.2010.00809.x.\u00a0PMID: 20836770.\u00a0<\/li>\n\n\n\n<li>Vrablik\u00a0ME, Snead GR,\u00a0Minnigan\u00a0HJ, Kirschner JM, Emmett TW,\u00a0Seupaul\u00a0RA. The diagnostic accuracy of bedside ocular ultrasonography for the diagnosis of retinal detachment: a systematic review and meta-analysis. Ann Emerg Med. 2015 Feb;65(2):199-203.e1.\u00a0doi: 10.1016\/j.annemergmed.2014.02.020.\u00a0Epub\u00a02014 Mar 27. PMID: 24680547.\u202f\u00a0<\/li>\n<\/ol>\n\n\n\n<ol start=\"2\" class=\"wp-block-list\"><\/ol>\n\n\n\n<ol start=\"3\" class=\"wp-block-list\"><\/ol>\n\n\n\n<ol start=\"4\" class=\"wp-block-list\"><\/ol>\n\n\n\n<ol start=\"5\" class=\"wp-block-list\"><\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"Theresa Jo Thomas\u202f,\u00a0Akash Desai Case: A&nbsp;49-year-old&nbsp;female with a past medical history of type 1 diabetes on insulin and myopia&nbsp;presented to the emergency department&nbsp;for vision changes.&nbsp;The patient&nbsp;stated&nbsp;that three days ago she&nbsp;noticed&nbsp;\u201cflashers\u201d in&nbsp;the&nbsp;vision of her right&nbsp;eye&nbsp;which she described as \u201csquiggly lines\u201d.&nbsp;The patient&nbsp;stated&nbsp;that on the day of her presentation to the emergency department at 1100 she noticed the &hellip; <p class=\"link-more\"><a href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2026\/03\/31\/case-64-ocular-emergencies-a-case-of-macula-on-retinal-detachment-seen-on-pocus\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> \"Case 64: Ocular emergencies: A case of macula-on retinal detachment\u00a0seen\u00a0on POCUS\u202f\u00a0\"<\/span><\/a><\/p>","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[4],"tags":[43,45],"class_list":["post-2583","post","type-post","status-publish","format-standard","hentry","category-clinical-cases","tag-ocular","tag-retinal-detachment"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 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