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Blinded by occlusion: transforming painless vision loss assessment in the ED

N Vuong1,2, E Richardson1,2, L Silva-Baucage3,4

  • 1Emergency Medicine Residency Program, UCF/HCA Florida Healthcare GME (Greater Orlando/Osceola), 700 W Oak St, Kissimmee, FL, 34741, USA.

Journal of Ultrasound
|June 25, 2025
PubMed

Insights

Painless vision loss, like Central Retinal Artery Occlusion (CRAO), is challenging in the ER. Point-of-Care Ultrasound can rapidly identify CRAO at the bedside using the retrobulbar spot sign.

Area of Science:

  • Emergency Medicine
  • Ophthalmology
  • Medical Ultrasound

Background:

  • Painless vision loss is a common emergency department presentation with a broad differential diagnosis.
  • Central Retinal Artery Occlusion (CRAO) is a critical diagnosis requiring urgent intervention.
  • Fundoscopic examination, essential for CRAO diagnosis, may not be routinely performed by emergency physicians.

Purpose of the Study:

  • To highlight the utility of Point-of-Care Ultrasound (POCUS) in the emergency department.
  • To demonstrate the bedside identification of CRAO using POCUS.
  • To introduce the retrobulbar spot sign (RBSS) as an ultrasound finding for CRAO.

Main Methods:

  • Case series design.
  • Utilized Point-of-Care Ultrasound (POCUS) for bedside examination.
  • Focused on identifying the retrobulbar spot sign (RBSS).

Main Results:

  • POCUS successfully aided in the rapid bedside identification of CRAO in the presented cases.
  • The retrobulbar spot sign (RBSS) was recognized as a key ultrasound finding.
  • Demonstrated the feasibility of using POCUS for ophthalmologic emergencies.

Conclusions:

  • Point-of-Care Ultrasound is a valuable tool for emergency physicians.
  • Integrating POCUS can expedite the recognition and management of CRAO.
  • POCUS enhances the diagnostic capabilities for ophthalmologic emergencies in the ED.

Keywords:
Central retinal artery occlusionOcular ultrasoundPainles vision lossRetrobulbar spot sign

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