CHEST Guidelines-Sudden-Unilateral-Vision-Loss-in-a-Patient-Who-Rec

Sudden-Unilateral-Vision-Loss-in-a-Patient-Who-Rec

Pdf Summary

A 65-year-old woman with hypertension and diabetes presented with chest pain and breathing difficulties, showing signs of a pulmonary embolism. She received intravenous thrombolytic therapy with alteplase, which improved her cardiopulmonary status. However, she subsequently experienced sudden vision loss in her right eye, accompanied by pain and headache. Fundoscopic examination revealed a fixed, nonreactive pupil and significantly elevated intraocular pressure, with choroidal elevation and vitreous hemorrhage detected despite limited examination capabilities.<br /><br />The medical team, using point-of-care ultrasound, diagnosed a spontaneous suprachoroidal hemorrhage with choroidal and retinal detachment, which is a rare condition most commonly occurring during or after intraocular procedures. In this case, it was precipitated by thrombolytic therapy, a less common complication known in the literature. An inferior vena cava filter was placed to prevent further hemorrhage, and ocular pressure was managed with topical medication. The patient later needed vitrectomy to address breakthrough hemorrhage.<br /><br />Point-of-care ultrasound emerged as a vital diagnostic tool due to its high sensitivity and specificity for detecting ocular diseases, particularly when traditional examinations are compromised by anatomical or logistical barriers. This technology offers rapid and dynamic assessment capabilities that are advantageous over more delayed and static imaging methods such as CT or MRI. The ultrasound examination was conducted using a high-frequency linear probe to provide real-time evaluation of potential ocular emergencies like the one faced by the patient, showing its utility in emergency contexts and its potential to improve patient outcomes by facilitating timely intervention.

Keywords

pulmonary embolism

thrombolytic therapy

suprachoroidal hemorrhage

point-of-care ultrasound

intraocular pressure

vitreous hemorrhage

choroidal detachment

inferior vena cava filter

ocular emergencies

vitrectomy