Dora Natasha Amran, Mohammad Zikri Ahmad, Mohd Boniami Yazid, Mohd Hashairi Fauzi, Shaik Farid Abdull Wahab, Kamilah Mohd Shafii, Zulaili Asri

AIM

To demonstrate the use of bedside ocular ultrasound to identify the cause of acute visual disturbances when fundus cannot be assessed on ophthalmoscopy.

METHODS

Acute ocular manifestation in the setting of hypertensive emergency is not as common as cerebral or coronary manifestation.

We reported a case of acute vitreous haemorrhage secondary to hypertensive emergency in a 38 years old lady with Type II diabetes mellitus and young hypertension who presented with sudden onset of right eye floaters, associated with dizziness, neck pain and throbbing occipital headache.

Vitals upon arrival showed BP of 226/109mmHg while others were normal. Visual acuity were normal and all pertinent examination were unremarkable except for the limited findings of blackish spots on fundoscopy.

All laboratory tests were within normal limits.

RESULTS / DISCUSSION

Bedside ocular ultrasound was performed using linear probe with 2 view in B-mode to visualise any ocular pathology which showed presence of hyperechoic lesion in vitreous chamber.

This indicate haemorrhage or tethering of hyperechoic retinal wall especially at posterior wall which can cover the optic nerve posteriorly in retinal detachment. From the systemic past medical history and ocular history with the above findings we conclude the patient as having vitreous haemorrhage secondary to hypertensive emergency.

She was then referred to Ophthalmology and Medical colleague for multidisciplinary team approach.

In this patient dilated fundus examination in ophthalmology clinic reveals right eye Proliferative Retinopathy (PDR) with Vitreous Haemorrhage (VH) and left eye moderate non proliferative retinopathy (NPDR). Diagnosis made was hypertensive emergency with vitreous haemorrhage of right eye and concurrent proliferative retinopathy.

Patient was then undergone Panretinal Photocoagulation (PRP) of right eye after BP stabilisation. 54% cases of vitreous haemorrhage are cause by proliferative retinopathy in which controlling blood pressure is the mainstay of treatment.

Meanwhile only 20% of cases are cause by retinal and vitreous detachment which required urgent surgical intervention. Ultrasound can reliably depict ocular anatomy and pathology such as detachment and haemorrhages.

CONCLUSION

Ocular ultrasounds helps emergency physician to identify the cause of acute visual loss when fundoscopy finding is very limited and time constraint in emergency department.

It is rapid, non-invasive, less discomfort to patient but provide direct visualisation of ocular structure. Thus in patient presented to emergency department with visual disturbances, using your clinical examination in conjunction with point-of-care ultrasound examination will allow for the highest level of care.