A 46 year old woman presents with relatively sudden painless visual field loss. She describes preceding flashers and floaters, and then a shadow falling over the medial and central part of her visual field.
View 2: Transverse image of the left eye
Describe and interpret these scans
Image 1: Transverse image of left eye. The echogenic retinal flap is seen moving with occular movement. It attaches posteriorly at the optic nerve. Retinal fibers pass into the optic nerve and detachment cannot occur at this point.
There is an associated vitreous detachment – much finer swirling debris is seen in the posterior chamber.
Image 2: Transverse image of the left eye with label. (with annotation below)
Vitreous detachment can also cause a swirling linear appearance in the posterior chamber.
Key differences between Vitreous and Retinal detachment:
- Retinal membrane far thicker and brighter than vitreous detachment
- Retinal detachment is anchored at the optic nerve and it flaps with eye movement rather than the vitreous which tends to swirl more freely.
- I do not use Doppler to assess the flap of a retinal detachment – although there should be vascularity in the retinal membrane and not in a vitreous detachment. Movement artifact complicates assessment.