A 56 year old female with a past medical history of atrial fibrillation on Coumadin, ESRD on hemodialysis, diabetes mellitus, hypertension and dyslipidemia presented to the emergency department with right eye vision loss. The patient states that 3 days ago she developed right eye floaters that then the following day progressed to “wavy lines” and eventually experienced near vision loss of the right eye. She also reports increasing pain to the right eye in the last day. Of note, she states that 4 days ago her Coumadin dose changed from 7.5 mg to 10 mg. She denies trauma to the eye, fever, or headache. She does no wear contact lenses or glasses.
Her physical exam showed visual acuity of 20/40 in the right eye and 20/20 in the left eye, a negative wood’s lamp examination, and ocular pressure of 16 mm Hg in the right eye, and 14 mm Hg in the left.
On bedside ultrasound examination of the right eye, there appeared to be a hyperechoic, continuous linear density arising from the fundus consistent with a retinal detachment (RD).
Other eye pathology can appear similar to RD on ultrasound, including posterior vitreous detachment (PVD) and vitreous hemorrhage (VD). RD appears as a thicker and less smooth linear density compared to a PVD. Also, when the patient moves the eye, a RD will move along with it, and a PVD will appear like “swaying seaweed”. A vitreous hemorrhage has a “snow globe” appearance, or “washing machine” sign.
The patient had urgent follow up arranged with an ophthalmologist for the following day.
Kahn A, Kahn AL, Corinaldi CA, Benitez FL, Fox PC. Retinal Detachment Diagnosed by Bedside Ultrasound in the Emergency Department. The California Journal of Emergency Medicine. 2005;6(3):47-51.
- Meina Michael, MD