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BET 2: The use of bedside ultrasound in diagnosing retinal detachment in emergency department

Abstract

A short-cut review was carried out to determine whether retinal detachment can be reliably diagnosed by an Emergency Department ocular ultrasound scan. Fifty eight papers were identified using the reported search, of which, eight were considered relevant to the three-part question. It is concluded by the limited evidence available that Emergency Department ocular ultrasound has promise as a sensitive test for retinal detachment.

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Report by: Dr J Wilkinson

Search checked by: Dr Laith Sultan

Institution: Royal Blackburn Hospital, Blackburn, UK

Clinical scenario

A 60-year-old female attends the emergency department complaining of floaters and visual loss affecting her right eye. You are concerned that she may have suffered a retinal detachment but are unable clinically to gain a clear view of the fundus. You wonder if ocular ultrasound would be helpful in diagnosing retinal detachment.

Three-part question

In (patients with suspected retinal detachment) can (bedside ultrasound) (confirm the diagnosis)?

Search strategy

((ultrasonography OR sonography OR ultrasound OR ultrasonics OR ultrasonography) AND (retina OR retinal OR detachment) AND (casualty OR emergency)).ti,ab Medline 1950 ­ 23rd September 2013 using the OVID interface. Embase ­ 1980 to 23rd September 2013.

British Nursing Index—1985 to 23rd September 2013 CINAHL—1981 to 23rd September 2013.

I also searched the Cochrane database and Google Scholar, and the reference lists of the relevant papers I had found were hand searched for any other relevant articles.

Search outcome

In total, 58 papers were identified using this search strategy, of which 8 were relevant to my clinical question.

Table 2

Relevant papers

Comments

Ocular ultrasound is a still a relatively new diagnostic tool for emergency physicians, and this is reflected in the fact that the eight studies I found included five case reports. Although the observational studies involved small sample sizes, ocular ultrasound was consistently found to be a very sensitive test. This was achieved with very little formal teaching; in one study the emergency practitioners received only a 30-min lecture on ocular ultrasound. The patients who were misdiagnosed in the studies all had vitreous haemorrhages and some had concomitant vitreous detachments. Acute vitreous haemorrhages typically appear minimally echogenic on US, but can become more echogenic and appear thickened with time, thus mimicking the appearance of a retinal detachment.

Clinical bottom line

  • Ocular ultrasound is a quick, accessible and accurate tool for the assessment of ocular pathology when performed by emergency physicians. Although this is a relatively new application for use of bedside ultrasound in the emergency department, the available evidence demonstrates that it is a sensitive test and that it is a skill that can be learned with minimal formal teaching.

  • Blaivas M, Theodoro D, Sierzenski PR. A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med 2002;9:791–9.

  • Kahn A, Kahn AL, Corinaldi CA, et al. Retinal detachment diagnosed by bedside ultrasound in the emergency department. Calif J Emerg Med 2005:6:47–51.

  • Lewin MR, Williams SR, Ahuja Y. Ultrasonographic diagnosis of retinal detachment in the emergency department. Ann Emerg Med 2005;45:97–8.

  • Elia J, Borger R. Diagnosis of retinal detachment in the ED with ultrasonography. J Emerg Med 2009;6:47–51.

  • Yoonessi R, Hussain A, Jang TB. Bedside ocular ultrasound for the detection of retinal detachment in the emergency department. Acad Emerg Med 2010;17:913–17.

  • Shinar Z, Chan L, Orlinsky M. Use of ocular ultrasound for the evaluation of retinal detachment. J Emerg Med 2011;40:53–7.

  • Palma J, Schott E. Acute, simultaneous, bilateral rhegmatogenous retinal detachment diagnosed with bedside emergency ultrasound. Am J Emerg Med 2013;31:466.e3–5.

  • Schott ML, Pierog JE, Williams SR. Pitfalls in the use of ocular ultrasound for evaluation of acute vision loss. J Emerg Med 2013;4:136–9.