A 72-year-old female presented to the ED with complaints of decreased vision in her right eye. Her vision had worsened over the past 4 days and she reported that when it started, it was as if a curtain was pulled over her right eye. There was no associated pain or trauma.
Visual acuity was 20/70 in the right and 20/30 in the left. Intraocular pressures were normal bilaterally.
A bedside ocular ultrasound was performed to investigate the cause of her vision change. Here is what was seen:
You can see that there is a thin string of echogenic material in the posterior chamber, but is this a vitreous detachment or a retinal detachment? Does it matter?
The answer is, yes, it does matter!
A vitreous detachment is usually benign and does not lead to vision loss. Retinal detachments, however, can lead to permanent vision loss if not treated in a timely matter.
The way to distinguish a vitreous detachment from a retinal detachment is to look at where the optic disc would be. If the echogenic material is tethered to the disc then it is a retinal detachment.
If it is not tethered to the optic disc, but rather is free floating in the posterior chamber, then it is a vitreous detachment.
Here is another view of the same eye:
You can see that the echogenic material is not tethered, and therefore, this is a vitreous detachment.
Look at our post on retinal detachment for comparison.
Ophthalmology did see the patient in the ED and agreed that this was a posterior vitreous detachment. The patient was discharged with no specific treatment.
Bottom Line: Ultrasound can easily distinguish vitreous detachment from retinal detachment by looking to see if the detachment is tethered at the optic disc or not.
