A 55 year old diabetic woman presents with painless loss of monocular vision. You wonder whether ultrasound will show a retinal detachment.
Describe and interpret these scans
Image 1: Transverse ocular ultrasound, patient looking right then left.
The posterior chamber is filled by swirling echogenic debris. This is a large amount of vitreous haemorrhage. The gelatinous liquid vitreous has detached and blood lies within and behind the collapsed vitreous.
The retina appears intact in this limited view. Whilst detachment is relatively easily see a retinal tear is not seen well with ultrasound. The optic nerve can be seen posteriorly. The anterior chamber is not well visualised – the transducer was placed superior to it.
Vitreous haemorrhage is not often as extensive as this, and smaller areas of the cloudy appearing swirling blood are more commonly seen.
In this case the extensive haemorrhage prevented ophthalmoscopic examination of the retina and we were asked to ensure there was not a large associated retinal detachment.
With retinal detachment a thicker detached membrane is seen, moving with eye movement but not swirling as freely as seen here. In addition retinal detachment never occurs at the optic nerve where retinal fibers run posteriorly into the optic nerve and anchor the retina at this point.