Case 53

46 year old male without medical problems taking no medications presents for “black spots” in his right eye vision since 9 pm yesterday. No pain, trauma, or full vision loss. Had LASIK 15 years ago without any complications. No other complaints.

Negative review of systems.

Physical exam:
Normal except for Eyes: PERRL, EOM intact; conjunctiva and sclera clear. VA: 20/20 bilaterally, no signs of corneal abrasion, IOP R 20 L 15

Bedside ultrasound shows the following:


  1. What do we see in these images?
  2. What are the two different types of retinal detachment that we can differentiate with ultrasound?
  3. Why is this differentiation important?
  4. What type of retinal detachment is demonstrated in this patient?
  5. What is the next best step in management?