- Email: [email protected]
63-Year-old female with acute vision change
Visual Journal of Emergency Medicine 6 (2017) 68–69
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
63-Year-old female with acute vision change a
Leonardo Ferraro , Viveta Lobo a b
MARK
b
Department of Anesthesia Federal University of Sao Paulo, Paulista Medical School Rua Napoleao de Barros, 715 Sao Paolo, Brasil 04024-002 Stanford University Medical Center, Stanford, CA, USA
A R T I C L E I N F O Keywords: Retinal detachment Orbital ultrasound Bedside ultrasound Point-of-care ultrasound
A 63 years-old female with a history hypertension presented with right eye visual change. Her complain was that she was seeing flashes of light and spots without any pain in both eyes The visual change started 3 h before presenting to the ER. The physical exam revealed normal vital signals but showed a decreased in visual acuity in the right eye. Her vision exam was 20/30 in the left, and 20/100 in right. Extra ocular movements and eye pressures were normal bilaterally. Based on the history and the physical exam, a bedside ultrasound in the right eye was performed and revealed a bright, continuous, smooth and somewhat folded membrane within the vitreous chamber, which was attached to the posterial orbital wall. This was considered to be a retinal detachment. Subsequently the patient was evaluated by ophthalmology and taken to the OR for surgical repair. Retinal detachment is a common ophthalmologic emergency seen in the Emergency Room and often requires prompt diagnosis and treatment [1]. Retinal detachment occurs when the neurosensory layer of the retina is separated from the underlying retinal pigment epithelium. The incidence is estimated to be 12 in 100,000 persons and the risk factors are age, ocular trauma, cataract surgery, family history of retinal detachment and a previous retinal detachment in the contralateral eye. The symptoms of the disease include flashes of light in one or both eyes, blurred vision, increases of floaters and visual defect in the peripheral vision. Bedside ultrasound can easily help to
E-mail address: [email protected] (V. Lobo). http://dx.doi.org/10.1016/j.visj.2016.09.008 Received 6 September 2016; Accepted 13 September 2016 2405-4690/ © 2016 Elsevier Inc. All rights reserved.
Fig. 1. Using a linear probe, a bedside ultrasound exam of the right orbit, shows a hyperechoic “ribbon” like structure within the vitreous chamber, that remains attached to the posterior orbital wall with eye movement. This represents a retinal detachment.
identify this pathology, decreasing time to surgical repair. Findings in ultrasound exam include a hyperechoic line in the vitreous chamber that is attached to the posterior wall of the globe[2,3] (Fig. 1).
Visual Journal of Emergency Medicine 6 (2017) 68–69
L. Ferraro, V. Lobo
2 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;6(3):47–51. 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.
Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at doi:10.1016/j.visj.2016.09.008. References 1 Gelston CD. Common eye emergencies. Am Fam Physician. 2013 15;88(8):515–519.
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Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
63-Year-old female with acute vision change a
Leonardo Ferraro , Viveta Lobo a b
MARK
b
Department of Anesthesia Federal University of Sao Paulo, Paulista Medical School Rua Napoleao de Barros, 715 Sao Paolo, Brasil 04024-002 Stanford University Medical Center, Stanford, CA, USA
A R T I C L E I N F O Keywords: Retinal detachment Orbital ultrasound Bedside ultrasound Point-of-care ultrasound
A 63 years-old female with a history hypertension presented with right eye visual change. Her complain was that she was seeing flashes of light and spots without any pain in both eyes The visual change started 3 h before presenting to the ER. The physical exam revealed normal vital signals but showed a decreased in visual acuity in the right eye. Her vision exam was 20/30 in the left, and 20/100 in right. Extra ocular movements and eye pressures were normal bilaterally. Based on the history and the physical exam, a bedside ultrasound in the right eye was performed and revealed a bright, continuous, smooth and somewhat folded membrane within the vitreous chamber, which was attached to the posterial orbital wall. This was considered to be a retinal detachment. Subsequently the patient was evaluated by ophthalmology and taken to the OR for surgical repair. Retinal detachment is a common ophthalmologic emergency seen in the Emergency Room and often requires prompt diagnosis and treatment [1]. Retinal detachment occurs when the neurosensory layer of the retina is separated from the underlying retinal pigment epithelium. The incidence is estimated to be 12 in 100,000 persons and the risk factors are age, ocular trauma, cataract surgery, family history of retinal detachment and a previous retinal detachment in the contralateral eye. The symptoms of the disease include flashes of light in one or both eyes, blurred vision, increases of floaters and visual defect in the peripheral vision. Bedside ultrasound can easily help to
E-mail address: [email protected] (V. Lobo). http://dx.doi.org/10.1016/j.visj.2016.09.008 Received 6 September 2016; Accepted 13 September 2016 2405-4690/ © 2016 Elsevier Inc. All rights reserved.
Fig. 1. Using a linear probe, a bedside ultrasound exam of the right orbit, shows a hyperechoic “ribbon” like structure within the vitreous chamber, that remains attached to the posterior orbital wall with eye movement. This represents a retinal detachment.
identify this pathology, decreasing time to surgical repair. Findings in ultrasound exam include a hyperechoic line in the vitreous chamber that is attached to the posterior wall of the globe[2,3] (Fig. 1).
Visual Journal of Emergency Medicine 6 (2017) 68–69
L. Ferraro, V. Lobo
2 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;6(3):47–51. 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.
Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at doi:10.1016/j.visj.2016.09.008. References 1 Gelston CD. Common eye emergencies. Am Fam Physician. 2013 15;88(8):515–519.
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