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Sono case series
Sono case series: a 65-year-old man with right eye vision loss
  1. William Shyy
  1. Emergency Medicine, University of California San Francisco, San Francisco, CA 94110, USA
  1. Correspondence to Dr William Shyy, Emergency Medicine, University of California San Francisco, San Francisco, CA 94110, USA; william.shyy{at}ucsf.edu

https://doi.org/10.1136/emermed-2019-209080

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    Case presentation

    A 65-year-old man presents with a shadow in the left visual field of his right eye. This has progressed over the past week, and he presents to the ED because the shadow has involved his central visual field. He has also been experiencing right eye flashes and floaters. He has not had any trauma to the eye, and has no eye pain, discharge, fever, chills or history of similar symptoms.

    His medical history includes diabetes, hypertension, hyperlipidemia, right eye pseudophakia, and right eye retinal microaneurysm. His surgical history includes lens replacement. His home medications include lisinopril, amlodipine, metformin and atorvastatin, and he has no allergies.

    His triage vital signs showed BP of 178/80 mm Hg, HR of 98 beats per minute, temperature of 37°C, respirations of 14 and oxygen saturation of 98%.

    On physical examination, the patient is a man appearing his stated aged without distress. Right eye visual acuity was 20/30, not correctable with pinhole, and left eye visual acuity was 20/20. Tonometry shows 15 mm Hg in both eyes. Both pupils are equal, round and reactive to light. The right eye has total inferior nasal visual field deficiency, while the left eye visual field is full. Slit lamp exam showed normal conjunctivae, cornea and anterior chambers.

    Questions

    1. What is the appropriate technique to perform a point-of-care ultrasound to evaluate for a retinal detachment?

    Place a transparent dressing (Tegaderm) on a high-frequency, linear transducer, and then apply sterile gel lubricant on top of the dressing. With the patient in supine or semirecumbent position, hold the transducer lightly …

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    Footnotes

    • Contributors WS was the sole author of this publication. He obtained the images in this manuscript with a signed consent from the patient. He created the figures and wrote the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.