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Case 2: Blurred vision, clear diagnosis. Ebrahem E. 2:12-1-25
A male patient in his 80s presented by ambulance after suffering a fall whilst standing as a passenger on a bus. He fell down injuring the back of his head. His main complaint was a headache and blurred vision in both eyes. He was not on any anticosagulation therapy.
PMHx: Hypertension, Bengin Prostatic Hyperplasia
Vitals:- RR15, S96% on RA, BP 130/88mmHg, T36.5ºC, GCS 15
On Cranial nerve examination his visual acuity was 3/6 bilaterally whilst wearing his usual spectacles. He reported blurred vision with floaters. CT head and C-spine reported as normal. Given his head injury and new onset of floaters, an ocular ultrasound was carried out under Consultant supervision.
Ebrahem eye.mp4The scan showed a flap moving around in a swirling motion when the patient was asked to look left and right. This flap extending transversely accross the posterior chamber of the eye, crossing the midline. Some mobile echogenic material can also be appreciated in the posteiror chamber. These signs were consistent with a Posterior Vitreous Detachment (PVD) and the mobile material possibly representing some Posterior viterous haemorrage. The patient was sent to a specialist eye unit who confirmed the diagnosis.
Summary of key points:
Acute visual symptoms should not be ignored, especially in the context of head trauma. CT head may be reported normal and even fundoscopy in the hands of non-opthalmologists may not reveal any major concerns. These patients still require specialist eye clinic review.
Ocular US is a niche and skilled scan that requires senior supervision - where possible in ED, it can reveal amazing diagnoses and aid in patient management. In this case it is interesting to note the difference between a Posterior Vitreous Detachment and a Retinal Detachment. Check out this video to learn more.
Trainee Lead Editor: Dr Amy Knowles, ST5
Checked: Dr Ahmed Abdul-Ghani, Lead Project Consultant
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