SAEM Clinical Image Series: Seeing Stars

Sep 30, 19

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Chief complaint: Left eye pain, redness, and foreign body sensation

History of Present Illness: 39 year old man presents after metal grinding without protective eyewear three days prior.

He had felt something strike his left eye. He developed “burning” pain, tearing, and redness. Pain worsens with extraocular movements. He notes that vision in his right eye has always been worse than the left. Denies any other visual complaints.

Note that this an ultrasound of the right eye. The first image above was an ultrasound of the left eye. In his right eye ultrasound, the hyperechoic material swirled within the posterior chamber with eye movement and was not tethered.

Physical Exam

Visual Acuity: OD 20/100, OS 20/25

Intraocular Pressure: 15 mmHg

Occular: Normal lids and lashes bilaterally. Pupils equal round and reactive to light. Extraoccular muscles intact. Visual fields intact. Conjunctival injection OS with limbic sparing 0.4 x 0.4 mm corneal rust ring OS at 3 o’clock.

Laboratory Data

N/A

Case Question: Which part of the eye is affected? What is on your differential?

The images show a collection of hyperechoic material in the vitreous body of both eyes.

Ophthalmology was consulted for concern of traumatic vitreous pathology (retinal or posterior vitreous detachments). They did not identify this, but instead identified asteroid hyalosis. Asteroid hyalosis is a degenerative condition of the eye in which calcium, phosphorous, and lipids collect in the vitreous humor. It rarely affects visual acuity and does not generally require treatment. Ultrasonographic appearance mimics that of vitreous hemorrhage.

Case Discussion

Take Home Points

Asteroid hyalosis is a benign ocular condition characterized by calcium, phosphorous, and lipid deposition in the vitreous humor.
On ultrasound, it has the appearance of hyperechoic opacities in the vitreous body, mimicking a vitreous hemorrhage.
Patients are typically asymptomatic and do not require treatment.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other other cases from this series on ALiEM.