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The speed of sound: Symptoms : Right eye pain : Emergency Medicine News


ultrasound, right eye pain, laceration, asteroid hyalosis


A 55-year-old man complained of pain in his right eye. He reported that the pain started after he hit his head against a door.

He noted floaters in that eye, but said they had been there for several years.

He had a history of diabetes and hypertension. His physical examination was significant for a superficial laceration to his left eyebrow. An external eye examination was within normal limits and visual acuity was impaired in both eyes, although it was corrected with a bilateral pinhole.

A bedside ultrasound was performed to assess for trauma (shown). What is the diagnosis? See discussion on next page.

Diagnosis: asteroid hyalosis

This ultrasound showed asteroid hyalosis, a rare condition in which calcium-lipid complexes are deposited throughout the vitreous body. It appeared at first glance similar to a vitreous hemorrhage, which initially caused confusion in this case.

Vitreous hemorrhage refers to the finding of blood products in the vitreous compartment. It can often be caused by uncontrolled diabetes, retinal or vitreous detachment, or trauma. It appears on ultrasound as particles of varying echogenicity in the vitreous compartment of the eye. It will appear to swirl with eye movement (sometimes described as a snow globe appearance) and will deposit toward the posterior globe when the eye is at rest. Vitreous hemorrhage can appear as tiny particles, large clumps representing an organized thrombus, or a combination of both.


In contrast, asteroid hyalosis appears more echogenic due to its calcium content. The particles can be seen flickering or flickering, but they are usually not as mobile and will appear to be suspended in the vitreous, not settling on the posterior globe.

Asteroid hyalosis is a degenerative condition most commonly seen in older men. It can sometimes affect visual acuity, but it is most often an incidental finding on fundus or ultrasound.

Being aware of asteroid hyalosis and its appearance can make the difference in avoiding a misdiagnosis.

Dr. Buttsis Director of the Division of Emergency Ultrasound and Clinical Associate Professor of Emergency Medicine at Louisiana State University in New Orleans. Follow her on Twitter@EMNSpeedofSound, and read its past columns at

Watch two videos demonstrating the ultrasound of this patient with asteroid hyalosis at