To see, or not to see

History

This patient presented with sudden onset painless visual field defect.

Answer

Retinal detachment

Retinal detachment

  • This is the typical appearance of a retinal detachment.
  • The echogenic retinal membrane normally attached to the back of the globe has separated.
  • Attachment at the disc confirms this is a retinal detachment (retinal neurons run into the disc and separation cannot occur).
  • Fine echogenic debris is seen in the vitreous and is consistent with earlier vitreous detachment which often precedes and contributed to retinal detachment. Vitreous haemorrhage can apear similar.

  • Ocular ultrasound is relatively easily performed without patient discomfort.
  • Confirming a retinal detachment is easy; ruling out a small detachment or tear is much more difficult.
  • It is important to avoid confusion with other pathology including vitreous detachment. Compared to retinal detachment, vitreous detachment does separate from the disc (the Weiss ring seen on fundoscopy), is much finer requiring increased gain settings to visualise well, and is usually seen as much more delicate linear structure with associated particulate debris that swirls within the vitreous with eye movement.

About James Rippey

Emergency physician with a passion for ultrasound and educating the masses @theSonoCave + James Rippey

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