Emergency diagnosis of diabetic vitreous hemorrhage using ocular point-of-care ultrasound

Emergency diagnosis of diabetic vitreous hemorrhage using ocular point-of-care ultrasound | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Emergency diagnosis of diabetic vitreous hemorrhage using ocular point-of-care ultrasound Eugenia Morello¹, Davide Castiglioni¹, Rossana Izzo¹, Simone Cosci¹, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7255907/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Vitreous hemorrhage requires urgent ophthalmologic evaluation. In emergency settings, point-of-care ultrasound (POCUS) enables early identification and management. We present the case of a 24-year-old male with type 1 diabetes who presented with acute floaters. Bedside ocular ultrasound revealed mobile echogenic material in the vitreous, consistent with hemorrhage [6]. This diagnosis was confirmed by ophthalmology and led to timely laser therapy and anti-VEGF treatment. This case highlights the utility of ocular POCUS in diagnosing sight-threatening conditions in resource-limited emergency departments. Figures Figure 1 Figure 2 Background Vitreous hemorrhage (VH) is defined as the extravasation of blood into the vitreous humor, the gelatinous substance located between the lens and the retina. This condition can result from mechanical disruption of normal blood vessels or pathological vessels, such as those seen in advanced diabetic proliferative retinopathy. Diabetic retinopathy is the leading cause of VH, accounting for 30–40% of cases, particularly in its advanced stages, where fragile neovascularization predisposes to spontaneous bleeding [1]. Other significant causes include retinal tears and detachments (10–20%), central retinal vein occlusion (10–15%), and ocular trauma (10–20%), often accompanied by additional injuries such as retinal or choroidal tears [1]. Less commonly, VH may result from pathological neovascularization secondary to retinal ischemia, intraocular tumors (e.g., choroidal melanoma), surgical complications, hematological or systemic conditions such as disseminated intra-vascular coagulation and hemophilia [2,3] [2,3]. The symptoms of VH vary based on severity and the underlying cause but commonly include an acute reduction in visual acuity, characterized by sudden vision changes such as blurriness, haziness, or diminished clarity. Other common symptoms include floaters in the visual field, a reddish tint to vision, and flashes of light. Diagnosing VH necessitates a detailed patient history and a comprehensive clinical examination. Examining the fellow eye can provide critical clues to the underlying etiology, particularly in systemic conditions. A dilated fundus examination can reveal the presence of blood in the vitreous humor, while fundus fluorescein angiography (FFA) is valuable for identifying areas of capillary non-perfusion and neovascularization [4] [4]. Ocular ultrasonography is an important diagnostic tool especially in helping to differentiate vitreous hemorrhage, retinal detachment, and vitreous detachment [8,9]. A precise distinction of these conditions is crucial, as untreated cases can progress to retinal detachment, neovascular glaucoma, or permanent vision loss [5] [5]. Patients with these ocular conditions require prompt ophthalmological evaluation to ensure an accurate diagnosis and the initiation of appropriate, timely treatment. Treatment options for these conditions include a range of approaches, depending on the severity and specifics of the diagnosis [4]. These may involve observation for less critical cases, laser photocoagulation to treat retinal abnormalities, cryotherapy to address retinal tears, and intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents to manage conditions like diabetic retinopathy or macular degeneration. In severe cases, surgical intervention may be necessary, with pars plana vitrectomy being the cornerstone treatment for managing VH and retinal detachment. This surgical approach allows for direct intervention to preserve vision and address underlying retinal pathology. We present the case of a young diabetic male who was diagnosed with VH in the emergency department using ocular POCUS. Case Presentation A 24-year-old male with type 1 diabetes mellitus presented to the emergency department (ED) with acute onset of red floaters in the left visual field, persisting for four hours. Five days prior, he had experienced hypoglycemia-induced syncope with mild head trauma. At presentation, vital signs and neurological examination were normal. Extraocular movements were intact and pupils were reactive. Investigations Ocular POCUS was performed using a high-frequency linear probe (10 MHz) with the patient in supine position. A transparent film was placed over the closed eyelid, and gel applied. The right eye appeared normal (Image 1), while the left eye showed mobile hyperechoic echoes within the vitreous body (Image 2), suggestive of vitreous hemorrhage [6]. The patient was referred to ophthalmology. Fundoscopy and fluorescein angiography the following day confirmed severe bilateral proliferative diabetic retinopathy and left VH. Treatment Bilateral panretinal laser photocoagulation was initiated four days later. Persistent ischemia on follow-up angiography prompted repeat laser therapy and initiation of intravitreal anti-VEGF therapy, with reported improvement. Outcome and Follow-Up Ocular POCUS is a rapid, non-invasive tool that enhances diagnostic confidence in emergency settings. In patients with acute visual symptoms and no immediate access to ophthalmology, POCUS can help identify vitreous hemorrhage and prompt appropriate management. Discussion Ocular POCUS is increasingly recognized as a valuable tool in EDs for evaluating acute visual disturbances, especially where ophthalmologists are not immediately accessible. Indications include trauma (excluding globe rupture), visual loss, and ocular pain [6,7] [6,7]. VH appears on ultrasound as swirling, mobile echogenic material within the vitreous. Differentiation from retinal detachment (tethered to optic nerve head) or vitreous detachment [8,9] (membranous, mobile structure) is essential [8,9]. In our case, the availability of ocular POCUS enabled timely identification of VH, avoided unnecessary delay, and facilitated early referral and treatment. This highlights the relevance of ultrasound training for ED physicians in managing ophthalmic emergencies. While POCUS does not replace ophthalmologic expertise, it provides critical early insight when time and resources are limited. Its use may be especially impactful in Swiss regional hospitals or low-resource settings lacking round-the-clock specialist coverage [10,11] [10,11]. Clinical Message Vitreous hemorrhage requires prompt diagnosis and urgent treatment. In emergency departments without 24/7 ophthalmologic coverage [10,11], ocular point-of-care ultrasound (POCUS) enables rapid, bedside diagnosis and supports critical early management decisions. Learning Points - Ocular POCUS enables timely diagnosis of vitreous hemorrhage in emergency settings. - Differentiation between VH, retinal detachment, and vitreous detachment is essential for appropriate management. - Emergency physicians should receive training in ocular ultrasound to enhance early recognition of sight-threatening conditions. Declarations Ethics approval and consent to participate Not applicable. Consent for publication The authors obtained written informed consent from the patient to publish this report in accordance with the journal’s patient consent policy. Availability of data and materials Not applicable. Competing interests The authors declare that they have no competing interests. Funding The authors received no specific funding for this work. Authors' contributions EM, DC, RI, and CG contributed to clinical data acquisition and manuscript drafting. SC supervised the project and critically revised the manuscript. All authors read and approved the final version. Acknowledgements Not applicable.Key References Spraul CW, Grossniklaus HE. Vitreous Hemorrhage. Surv Ophthalmol. 1997 Jul-Aug;42(1):3-39. Azar P, Smith RS, Greenberg MH Ocular findings in disseminated intravascular coagulation. Am J Ophthalmol 1974; 78:493–6. Kobayashi H, Honda Y Intraocular haemorrhage in a patient with hemophilia. Metab Ophthalmol Pediatr Systemic 1984; 8:27–30. Shaikh N, Srishti R, Khanum A, et al, Vitreous hemorrhage - Causes, diagnosis, and management. Indian J Ophthalmol. 2023 Jan;71(1):28-38. Jersey A, Perice L, Li N, Johnson J, Dulani T. Acute Angle-Closure Glaucoma Secondary to Vitreous Hemorrhage Diagnosed with the Aid of Point-of-Care Ultrasound. J Emerg Med. 2020 Dec;59(6): e235-e237. Skidmore C, Saurey T, Ferre R, et al. A narrative review of common uses of ophthalmic ultrasound in Emergency Medicine. J Emerg Med. 2021 ;60(1):80–89. Schott ML, Pierog JE, Williams SR. Pitfalls in the use of ocular ultrasound for evaluation of acute vision loss [7]. J Emerg Med. 2013;44(6):1136–1139. De La Hoz Polo M, Torramilans Lluís A, Pozuelo Segura O, Anguera Bosque A, Esmerado Appiani C, Caminal Mitjana JM. Ocular ultrasonography focused on the posterior eye segment: what radiologists should know. Insights Imaging. 2016 Jun;7(3):351-64. Lahham S, Shniter I, Thompson M, Le D, Chadha T, Mailhot T, Kang TL, Chiem A, Tseeng S, Fox JC. Point-of-Care Ultrasonography in the Diagnosis of Retinal Detachment, Vitreous Hemorrhage, and Vitreous Detachment in the Emergency Department. JAMA Netw Open. 2019 Apr 5;2(4): e192162. Shinar Z, Chan L, Orlinsky M. Use of ocular ultrasound for the evaluation of retinal detachment. J Emerg Med. 2011 Jan;40(1):53-7. Habib A, Laamia A, Zafar F, Akram Z, Fatima, Raza M, Ghazanfar S. Diagnostic Accuracy of Ocular Ultrasound in the Assessment of Vitreous Hemorrhage and Associated Ocular Diseases. Journal of Health and Rehabilitation Research (2791-156X), Volume 4, Issue 3, 2024 Aug. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7255907","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":502135412,"identity":"1c6208d6-c0e7-411b-b7f7-da6a63f0cb4c","order_by":0,"name":"Eugenia Morello¹","email":"","orcid":"","institution":"Ente Ospedaliero Cantonale - Ospedale Regionale di Bellinzona e Valli","correspondingAuthor":false,"prefix":"","firstName":"Eugenia","middleName":"","lastName":"Morello¹","suffix":""},{"id":502135414,"identity":"cbc559f4-a4ee-4995-8299-1d5c1e685ef4","order_by":1,"name":"Davide Castiglioni¹","email":"","orcid":"","institution":"Ente Ospedaliero Cantonale - Ospedale Regionale di Bellinzona e Valli","correspondingAuthor":false,"prefix":"","firstName":"Davide","middleName":"","lastName":"Castiglioni¹","suffix":""},{"id":502135416,"identity":"63f9efd6-40a0-4a39-9da4-723431101d27","order_by":2,"name":"Rossana Izzo¹","email":"","orcid":"","institution":"Ente Ospedaliero Cantonale - Ospedale Regionale di Bellinzona e Valli","correspondingAuthor":false,"prefix":"","firstName":"Rossana","middleName":"","lastName":"Izzo¹","suffix":""},{"id":502135417,"identity":"2413ea32-e507-40b2-8d07-1eb49b395d36","order_by":3,"name":"Simone Cosci¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDACZiT2gQ9giocELQdnEKUFRTsPMVrk27kTHxdUMMjz8x9+eNimwkaegf3sAbxaDA7zbjaecYbBcOaMNIPDOWfSDBt48hLwa2Hm3SbN28aQYHCDh+FwbtvhBAYJHgP8DmsGafkH1HL+DMNhy39EaGE4DNLSANRyIIfhMGMDEVrAfuE5JgH2y8GeY2mGbTw5BBzWf3bjY54aG1CIPf7wA8RgP0PAYRAggWCyEaN+FIyCUTAKRgF+AAD+sDvr0bOQmQAAAABJRU5ErkJggg==","orcid":"","institution":"Ente Ospedaliero Cantonale - Ospedale Regionale di Bellinzona e Valli","correspondingAuthor":true,"prefix":"","firstName":"Simone","middleName":"","lastName":"Cosci¹","suffix":""},{"id":502135418,"identity":"49f775b3-a003-43db-893f-180ab2c9e063","order_by":4,"name":"Camilla Galbusera¹","email":"","orcid":"","institution":"Ente Ospedaliero Cantonale - Ospedale Regionale di Bellinzona e Valli","correspondingAuthor":false,"prefix":"","firstName":"Camilla","middleName":"","lastName":"Galbusera¹","suffix":""}],"badges":[],"createdAt":"2025-07-30 19:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7255907/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7255907/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89987943,"identity":"a5780064-c926-4bc5-b8b1-dad630047acf","added_by":"auto","created_at":"2025-08-27 07:02:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74197,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Image1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7255907/v1/f310ffe391c0d153ac8a5cd6.jpg"},{"id":89987946,"identity":"bfd7f68f-4d63-4ac1-ab5f-4d6c7e5aab72","added_by":"auto","created_at":"2025-08-27 07:02:31","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":73528,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Image2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7255907/v1/89f1b064aae8fb704ca8f5a3.jpg"},{"id":91287858,"identity":"8133bab9-ab41-46cf-8cd5-b05e026765a1","added_by":"auto","created_at":"2025-09-14 20:46:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":495913,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7255907/v1/baa47460-97ab-49de-9c09-c3565c9f6812.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Emergency diagnosis of diabetic vitreous hemorrhage using ocular point-of-care ultrasound","fulltext":[{"header":"Background","content":"\u003cp\u003eVitreous hemorrhage (VH) is defined as the extravasation of blood into the vitreous humor, the gelatinous substance located between the lens and the retina.\u003c/p\u003e\u003cp\u003eThis condition can result from mechanical disruption of normal blood vessels or pathological vessels, such as those seen in advanced diabetic proliferative retinopathy. Diabetic retinopathy is the leading cause of VH, accounting for 30\u0026ndash;40% of cases, particularly in its advanced stages, where fragile neovascularization predisposes to spontaneous bleeding [1]. Other significant causes include retinal tears and detachments (10\u0026ndash;20%), central retinal vein occlusion (10\u0026ndash;15%), and ocular trauma (10\u0026ndash;20%), often accompanied by additional injuries such as retinal or choroidal tears [1]. Less commonly, VH may result from pathological neovascularization secondary to retinal ischemia, intraocular tumors (e.g., choroidal melanoma), surgical complications, hematological or systemic conditions such as disseminated intra-vascular coagulation and hemophilia [2,3] [2,3].\u003c/p\u003e\u003cp\u003eThe symptoms of VH vary based on severity and the underlying cause but commonly include an acute reduction in visual acuity, characterized by sudden vision changes such as blurriness, haziness, or diminished clarity. Other common symptoms include floaters in the visual field, a reddish tint to vision, and flashes of light.\u003c/p\u003e\u003cp\u003eDiagnosing VH necessitates a detailed patient history and a comprehensive clinical examination. Examining the fellow eye can provide critical clues to the underlying etiology, particularly in systemic conditions. A dilated fundus examination can reveal the presence of blood in the vitreous humor, while fundus fluorescein angiography (FFA) is valuable for identifying areas of capillary non-perfusion and neovascularization [4] [4]. Ocular ultrasonography is an important diagnostic tool especially in helping to differentiate vitreous hemorrhage, retinal detachment, and vitreous detachment [8,9]. A precise distinction of these conditions is crucial, as untreated cases can progress to retinal detachment, neovascular glaucoma, or permanent vision loss [5] [5]. Patients with these ocular conditions require prompt ophthalmological evaluation to ensure an accurate diagnosis and the initiation of appropriate, timely treatment.\u003c/p\u003e\u003cp\u003eTreatment options for these conditions include a range of approaches, depending on the severity and specifics of the diagnosis [4]. These may involve observation for less critical cases, laser photocoagulation to treat retinal abnormalities, cryotherapy to address retinal tears, and intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents to manage conditions like diabetic retinopathy or macular degeneration. In severe cases, surgical intervention may be necessary, with pars plana vitrectomy being the cornerstone treatment for managing VH and retinal detachment. This surgical approach allows for direct intervention to preserve vision and address underlying retinal pathology. We present the case of a young diabetic male who was diagnosed with VH in the emergency department using ocular POCUS.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 24-year-old male with type 1 diabetes mellitus presented to the emergency department (ED) with acute onset of red floaters in the left visual field, persisting for four hours. Five days prior, he had experienced hypoglycemia-induced syncope with mild head trauma. At presentation, vital signs and neurological examination were normal. Extraocular movements were intact and pupils were reactive.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eInvestigations\u003c/h2\u003e\u003cp\u003eOcular POCUS was performed using a high-frequency linear probe (10 MHz) with the patient in supine position. A transparent film was placed over the closed eyelid, and gel applied. The right eye appeared normal (Image 1), while the left eye showed mobile hyperechoic echoes within the vitreous body (Image 2), suggestive of vitreous hemorrhage [6].\u003c/p\u003e\u003cp\u003eThe patient was referred to ophthalmology. Fundoscopy and fluorescein angiography the following day confirmed severe bilateral proliferative diabetic retinopathy and left VH.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTreatment\u003c/h3\u003e\n\u003cp\u003eBilateral panretinal laser photocoagulation was initiated four days later. Persistent ischemia on follow-up angiography prompted repeat laser therapy and initiation of intravitreal anti-VEGF therapy, with reported improvement.\u003c/p\u003e\n\u003ch3\u003eOutcome and Follow-Up\u003c/h3\u003e\n\u003cp\u003eOcular POCUS is a rapid, non-invasive tool that enhances diagnostic confidence in emergency settings. In patients with acute visual symptoms and no immediate access to ophthalmology, POCUS can help identify vitreous hemorrhage and prompt appropriate management.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOcular POCUS is increasingly recognized as a valuable tool in EDs for evaluating acute visual disturbances, especially where ophthalmologists are not immediately accessible. Indications include trauma (excluding globe rupture), visual loss, and ocular pain [6,7] [6,7].\u003c/p\u003e\u003cp\u003eVH appears on ultrasound as swirling, mobile echogenic material within the vitreous. Differentiation from retinal detachment (tethered to optic nerve head) or vitreous detachment [8,9] (membranous, mobile structure) is essential [8,9].\u003c/p\u003e\u003cp\u003eIn our case, the availability of ocular POCUS enabled timely identification of VH, avoided unnecessary delay, and facilitated early referral and treatment. This highlights the relevance of ultrasound training for ED physicians in managing ophthalmic emergencies.\u003c/p\u003e\u003cp\u003eWhile POCUS does not replace ophthalmologic expertise, it provides critical early insight when time and resources are limited. Its use may be especially impactful in Swiss regional hospitals or low-resource settings lacking round-the-clock specialist coverage [10,11] [10,11].\u003c/p\u003e"},{"header":"Clinical Message","content":"\u003cp\u003eVitreous hemorrhage requires prompt diagnosis and urgent treatment. In emergency departments without 24/7 ophthalmologic coverage [10,11], ocular point-of-care ultrasound (POCUS) enables rapid, bedside diagnosis and supports critical early management decisions.\u003c/p\u003e"},{"header":"Learning Points","content":"\u003cp\u003e- Ocular POCUS enables timely diagnosis of vitreous hemorrhage in emergency settings.\u003c/p\u003e\n\u003cp\u003e- Differentiation between VH, retinal detachment, and vitreous detachment is essential for appropriate management.\u003c/p\u003e\n\u003cp\u003e- Emergency physicians should receive training in ocular ultrasound to enhance early recognition of sight-threatening conditions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors obtained written informed consent from the patient to publish this report in accordance with the journal\u0026rsquo;s patient consent policy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEM, DC, RI, and CG contributed to clinical data acquisition and manuscript drafting. SC supervised the project and critically revised the manuscript. All authors read and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.Key\u003c/p\u003e\n"},{"header":"References ","content":"\u003col\u003e\n \u003cli\u003eSpraul CW, Grossniklaus HE. Vitreous Hemorrhage. Surv Ophthalmol. 1997 Jul-Aug;42(1):3-39.\u003c/li\u003e\n \u003cli\u003eAzar P, Smith RS, Greenberg MH Ocular findings in disseminated intravascular coagulation. Am J Ophthalmol 1974; 78:493\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eKobayashi H, Honda Y Intraocular haemorrhage in a patient with hemophilia. Metab Ophthalmol Pediatr Systemic 1984; 8:27\u0026ndash;30.\u003c/li\u003e\n \u003cli\u003eShaikh N, Srishti R, Khanum A, et al, Vitreous hemorrhage - Causes, diagnosis, and management. Indian J Ophthalmol. 2023 Jan;71(1):28-38.\u003c/li\u003e\n \u003cli\u003eJersey A, Perice L, Li N, Johnson J, Dulani T. Acute Angle-Closure Glaucoma Secondary to Vitreous Hemorrhage Diagnosed with the Aid of Point-of-Care Ultrasound. J Emerg Med. 2020 Dec;59(6): e235-e237.\u003c/li\u003e\n \u003cli\u003eSkidmore C, Saurey T, Ferre R, et al. A narrative review of common uses of ophthalmic ultrasound in Emergency Medicine.\u0026nbsp;J Emerg Med.\u0026nbsp;2021 ;60(1):80\u0026ndash;89.\u003c/li\u003e\n \u003cli\u003eSchott ML, Pierog JE, Williams SR. Pitfalls in the use of ocular ultrasound for evaluation of acute vision loss [7].\u0026nbsp;J Emerg Med.\u0026nbsp;2013;44(6):1136\u0026ndash;1139.\u003c/li\u003e\n \u003cli\u003eDe La Hoz Polo M, Torramilans Llu\u0026iacute;s A, Pozuelo Segura O, Anguera Bosque A, Esmerado Appiani C, Caminal Mitjana JM. Ocular ultrasonography focused on the posterior eye segment: what radiologists should know. Insights Imaging. 2016 Jun;7(3):351-64.\u003c/li\u003e\n \u003cli\u003eLahham S, Shniter I, Thompson M, Le D, Chadha T, Mailhot T, Kang TL, Chiem A, Tseeng S, Fox JC. Point-of-Care Ultrasonography in the Diagnosis of Retinal Detachment, Vitreous Hemorrhage, and Vitreous Detachment in the Emergency Department. JAMA Netw Open. 2019 Apr 5;2(4): e192162.\u003c/li\u003e\n \u003cli\u003eShinar Z, Chan L, Orlinsky M. Use of ocular ultrasound for the evaluation of retinal detachment. J Emerg Med. 2011 Jan;40(1):53-7.\u003c/li\u003e\n \u003cli\u003eHabib A, Laamia A, Zafar F, Akram Z, Fatima, Raza M, Ghazanfar S. Diagnostic Accuracy of Ocular Ultrasound in the Assessment of Vitreous Hemorrhage and Associated Ocular Diseases. Journal of Health and Rehabilitation Research (2791-156X), Volume 4, Issue 3, 2024 Aug.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7255907/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7255907/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eVitreous hemorrhage requires urgent ophthalmologic evaluation. In emergency settings, point-of-care ultrasound (POCUS) enables early identification and management. We present the case of a 24-year-old male with type 1 diabetes who presented with acute floaters. Bedside ocular ultrasound revealed mobile echogenic material in the vitreous, consistent with hemorrhage [6]. This diagnosis was confirmed by ophthalmology and led to timely laser therapy and anti-VEGF treatment. This case highlights the utility of ocular POCUS in diagnosing sight-threatening conditions in resource-limited emergency departments.\u003c/p\u003e","manuscriptTitle":"Emergency diagnosis of diabetic vitreous hemorrhage using ocular point-of-care ultrasound","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 07:02:27","doi":"10.21203/rs.3.rs-7255907/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c0a1c3a7-c3e3-4afa-9722-5b6b6ecc846a","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-14T20:38:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 07:02:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7255907","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7255907","identity":"rs-7255907","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}