57-year-old man with floaters and rapid-onset vision loss | Figure 1

57-year-old man with floaters and rapid-onset vision loss

What is the role of the primary care or emergency medicine physician?

The patient should be referred to an ophthalmologist urgently (within 24 hours) due to concern for a retinal detachment and/or retinal tear that could progress to a retinal detachment.

What is the role of the ophthalmologist?

The role of the ophthalmologist includes the following:

• examining the eye with a slit-lamp biomicroscope
• assessing for location, size, and cause of vitreous hemorrhage
• B-scan ultrasonography can help detect vitreous hemorrhage, posterior vitreous detachment, retinal tears, and retinal detachment if a complete view of the retina is obscured.

What is the treatment?

Vitreous hemorrhage may resolve spontaneously in some cases. Treatment is based on the underlying cause.

Anti-vascular endothelial growth factor (anti-VEGF) injections and/or panretinal photocoagulation may be used to treat proliferative diabetic retinopathy. Scleral buckling, pneumatic retinopexy, and/or pars plana vitrectomy may be used to treat retinal detachments.

Review the full case on the Academy website for more details, including links to educational resources on key topics related to the case.

Diagnosis added by author

The image is consistent with a diagnosis of vitreous hemorrhage:

• Vitreous hemorrhage is a relatively common cause of acute vision loss, affecting about 7 in 100,000 individuals.
• The most common causes of vitreous hemorrhage are ocular trauma, proliferative diabetic retinopathy, and posterior vitreous detachment.
• Vitreous hemorrhage is managed by treating the underlying cause and monitoring for progression of the hemorrhage.