Painless loss of vision: rapid diagnosis of a central retinal artery occlusion utilizing point-of-care ultrasound

Gregory M Taylor; Daniel Evans; Robert P Doggette; Ryan C Wallace; Andrew T Flack; Sarah K Kennedy

doi:10.1093/omcr/omab038

Painless loss of vision: rapid diagnosis of a central retinal artery occlusion utilizing point-of-care ultrasound

Oxf Med Case Reports. 2021 Jun 18;2021(6):omab038. doi: 10.1093/omcr/omab038. eCollection 2021 Jun.

Authors

Gregory M Taylor¹, Daniel Evans², Robert P Doggette^{1

3}, Ryan C Wallace¹, Andrew T Flack¹, Sarah K Kennedy⁴

Affiliations

¹ Assistant Professor of Clinical Emergency Medicine, Indiana University School of Medicine, IU Health Ball Memorial Hospital, Muncie, IN, USA.
² Emergency Medicine Physician at Mercy Medical Center, Cedar Rapids, IA, USA.
³ Methodist Hospital, Indianapolis, IN, USA.
⁴ Associate Professor of Clinical Emergency Medicine and faculty for the Emergency Ultrasound Fellowship Program, Indiana University School of Medicine, Methodist Hospital, Indianapolis, IN, USA.

Abstract

Point-of-care ultrasound (POCUS) has become an essential part of the evaluation of vision loss among emergency physicians in the emergency department (ED). It is frequently used to evaluate for vitreous hemorrhage, foreign bodies, retinal detachment, optic neuritis and posterior vitreous detachment; however, it can also be used to evaluate for a central retinal artery occlusion (CRAO). A POCUS can reveal a hyperechoic density in the optic nerve sheath just proximal to the retinal surface, and this is referred to as a retrobulbar 'spot sign' (RBSS). We present the case of an 88-year-old male that presented to our community ED with a painless loss of vision to his right eye. A POCUS revealed an RBSS of the central retinal artery and he was subsequently diagnosed with a CRAO. At his 1-month follow-up, he has regained light perception and 15% of his vision, however, remains with significant visual impairment.

Publication types

Case Reports