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A 67-year-old man with a past medical history of hypertension presented to the emergency department (ED) with sudden onset of severely decreased vision in the right eye that he described as a “black veil” rising up from his inferior visual field. He also reported that 3 weeks ago he suffered complete visual loss in his left eye, at which time he did not seek any medical attention. He denied trauma, eye pain, headache, facial weakness, or any other focal neurologic deficits.

On examination of the right eye, the patient was able to count fingers at 3 feet, and there was an inferonasal visual field deficit. The patient was only able to faintly perceive hand motion with the left eye. While awaiting evaluation by ophthalmology, a bedside ocular ultrasound examination was performed by the treating emergency physician using a 12-5 MHz linear array transducer (GE Logiq P5, Wauwatosa, WI). Static examination of the right and left eyes demonstrated hyperechoic linear membranes in the posterior chamber suggestive of retinal detachment (Figure 1).

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Figure 1.  Transverse views of the eyes. These demonstrate linear hyperechoic membranes in the posterior chamber of both the right and the left eye.

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Oculokinetic echography was then performed during voluntary saccadic motion of the patient’s globe while the linear array probe remained stationary on the closed eyelid (Video Clips S1 and S2). Significant aftermovement of the hyperechoic linear membranes was noted, with more mobility in the patient’s right eye than in his left. Emergent ophthalmologic consultation confirmed bilateral retinal detachments with significant loss of central vision.

A retinal detachment refers to the separation of the retina from its underlying support tissue. This is one of the most time-critical ophthalmologic emergencies encountered in the ED, and ocular ultrasonography is a useful point-of-care adjunct in the evaluation of the patient with suspected retinal detachment. Kinetic echography is an easily performed technique that allows for more detailed evaluation of posterior chamber membranes and is well known to ophthalmologists,1 although there is little mention of this technique in the emergency medicine literature. During kinetic echography, the patient performs voluntary saccadic globe movements while the operator holds the ultrasound transducer still and evaluates for the presence or absence of continued movement in the posterior chamber membranes after the patient ceases eye movement. Acute retinal detachments demonstrate considerable motion of the membrane during and after eye movement, yet as time progresses, proliferative vitreoretinopathy occurs, the detached retina becomes more taut, and mobility as demonstrated on kinetic echography decreases (as seen in our patient’s left eye). Kinetic echography may also facilitate the diagnosis of choroidal detachment, which, during static ultrasound examination, appears as a thick and dome-shaped posterior chamber membrane that may be confused for a retinal detachment. On kinetic echography, however, there is virtually no mobility of the choroidal detachment, as opposed to the significant mobility associated with acute retinal detachment.

Point-of-care ocular ultrasonography has been previously described in the evaluation of ED patients with visual complaints,2 and physicians may consider the use of kinetic echography when evaluating the posterior chamber for the presence of retinal detachment.

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Video Clip S1. Right eye.

Video Clip S2. Left eye.

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FilenameFormatSizeDescription
ACEM_768_sm_VideoClipS1.mov678KSupporting info item
ACEM_768_sm_VideoClipS2.mov1293KSupporting info item

Please note: Wiley Blackwell is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.