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J Emerg Med. 2019 Jul 25. pii: S0736-4679(19)30345-2. doi: 10.1016/j.jemermed.2019.04.034. [Epub ahead of print]

Point-of-Care Ultrasound in the Evaluation of the Acutely Painful Red Eye.

Author information

1
Division of Emergency Ultrasound, Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
2
Division of Emergency Ultrasound, Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio.
3
M&M Eye Institute, Prescott, Arizona.

Abstract

BACKGROUND:

Visual loss, ocular pain, and red eye are common presentations to front-line physicians in the emergency department, urgent care centers, or the primary care office. In recent decades, point-of-care ultrasound (POCUS) has been used by clinicians at the bedside in the evaluation and management of a vast array of patients, including those with ocular complaints.

CASE REPORT:

A 33-year-old man presented to the emergency department with left eye pain for 4 weeks' duration. The physical examination revealed visual acuity of 20/400 in the affected eye and diffuse conjunctival injection with perilimbal sparing and scleral edema. Using POCUS, he was noted to have diffuse thickening of the globe wall in the symptomatic eye with a thin layer of fluid posterior to the globe in Tenon's space and mild enlargement of the optic nerve sheath diameter. He was ultimately diagnosed with posterior scleritis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Posterior scleritis carries the potential for significant visual impairment when the diagnosis is missed or delayed. POCUS findings can aid the front-line physician in making the diagnosis of posterior scleritis allowing earlier initiation of appropriate therapy and follow-up.

KEYWORDS:

POCUS; T sign; Tenon's space; emergency department; eye; ophthalmology; point-of-care ultrasound; posterior scleritis

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