Kevin Vo, MD; Rachna Subramony, MD
Case Presentation:
A 31-year-old male with no significant past medical history presented to the Emergency Department with bilateral blurry vision, left greater than right. He had been evaluated earlier that day by an optometrist and referred for concern of retinal detachment. The patient reported flashes and floaters of uncertain duration but denied eye pain, discharge, foreign body sensation, headache, or trauma.
Vital Signs: BP 132/77 mmHg | HR 60 bpm | Temp 97.3°F | RR 16 | SpO₂ 99%
Physical Examination:
The patient was in no acute distress. Ocular exam revealed mild conjunctival injection bilaterally. Intraocular pressures were 17 mmHg OS and 13 mmHg OD. Fluorescein exam showed no corneal uptake. Neurologic exam was normal; the patient was alert and oriented ×3 without focal deficits. The patient reported a superior visual field deficit in the left eye.
A bedside ultrasound was performed.
Figure 1 (video) : Echogenic detached membrane visualized in the posterior chamber of the left eye
Figure 2 (video): Detachment tethered to the optic nerve.
Discussion:
Point-of-care ultrasound (POCUS) is a valuable adjunct for emergency physicians in evaluating posterior ocular abnormalities. While anterior and external ocular conditions can often be diagnosed through history and physical examination, posterior chamber visualization is frequently limited in the emergency department due to the lack of specialized ophthalmic equipment and suboptimal exam conditions.
POCUS offers a noninvasive, rapid, and radiation-free imaging modality that can enhance diagnostic accuracy in the acute care setting. Meta-analyses and prospective studies have demonstrated POCUS sensitivity of 94–97% and specificity of 88–96% for detecting retinal detachment1,2,3. Given this high sensitivity, POCUS can serve as an effective rule-out tool when used in conjunction with ophthalmologic evaluation.
Retinal detachment typically appears as an echogenic, undulating membrane tethered to the optic nerve, a finding considered diagnostic in multiple studies.1,5 In this case, the optic nerve was difficult to visualize in the same plane as the detached membrane, making it challenging to definitively distinguish retinal from posterior vitreous detachment (Figure 2). However, given the patient’s corresponding visual field deficits and characteristic sonographic findings, the likelihood of retinal detachment remained high.
The use of POCUS for diagnosing vitreous detachment differs from its performance for retinal detachment. In one prospective study, sensitivity and specificity were 42.5% and 96% respectively.3 Another meta-analysis showed POCUS’s sensitivity to be 67% and specificity to be 90%. For other posterior eye pathologies, such as lens dislocation, foreign body, and globe rupture, sensitivity and specificity were high.1 The application of POCUS in this case was more suited for determining the presence of a retinal detachment and guiding the subsequent steps in management and further ophthalmologic assessment. The presence of vitreous detachment is difficult to rule out with the use of ultrasound alone.
Conclusion:
This case demonstrates POCUS’s utility as an adjunct to ophthalmologic examination in the evaluation of posterior ocular pathology. Retinal detachment, which typically requires more urgent intervention than posterior vitreous detachment, can be rapidly identified using POCUS in the emergency setting. In this case, ophthalmology was consulted, and the patient subsequently underwent a left eye vitrectomy with perfluoro-octane (PFO) tamponade for treatment of his retinal detachment.
References:
1.Propst SL, Kirschner JM, Strachan CC, et al. Ocular Point-of-Care Ultrasonography to Diagnose Posterior Chamber Abnormalities. JAMA Network Open. 2020;3(2):e1921460. doi:https://doi.org/10.1001/jamanetworkopen.2019.21460
2.Gottlieb M, Holladay D, Peksa GD. Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis. Carpenter CR, ed. Academic Emergency Medicine. 2019;26(8):931-939. doi:https://doi.org/10.1111/acem.13682
3.Lahham S, Shniter I, Thompson M, et al. Point-of-Care Ultrasonography in the Diagnosis of Retinal Detachment, Vitreous Hemorrhage, and Vitreous Detachment in the Emergency Department. JAMA Network Open. 2019;2(4). doi:https://doi.org/10.1001/jamanetworkopen.2019.2162
4.Ocular Ultrasound Made Easy: Step-By-Step Guide - POCUS 101. POCUS 101. Published 2018. Accessed August 4, 2025. https://www.pocus101.com/ocular-ultrasound-made-easy-step-by-step-guide/#Posterior_Vitreou s_Detachment_PVD
5.Kim DJ, Francispragasam M, Docherty G, et al. Test Characteristics of Point‐of‐care Ultrasound for the Diagnosis of Retinal Detachment in the Emergency Department. Theodoro DL, ed. Academic Emergency Medicine. Published online December 17, 2018. doi:https://doi.org/10.1111/acem.13454