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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Retina

Case 40

Patient Presentation: A 34-year-old presents to the emergency department after waking up this morning with blurred vision and floaters OS. On exam, visual acuity is 20/20 OD, 20/60 OS. There is no indirect ophthalmoscope available in the emergency room, but there is surprisingly an OCT machine at your disposal. OCT macula OS is shown below:

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Question: Is this an OCT image of the right or left eye?

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Question: What abnormal findings are seen on OCT?

A. Detached posterior hyaloid

B. Epiretinal membrane

C. Hyper-reflective dots in the vitreous cavity

Question: On further history, the patient is a type 1 diabetic with poor control of his blood sugar levels. Given this information, what do the hyper-reflective dots in the vitreous likely represent?

A. Vitreous hemorrhage

C. Asteroid hyalosis

D. Synchysis scintillans

Learning Objectives:

1. To diagnose and recognize vitreous hemorrhage on OCT

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