Asteroid Hyalosis Mimicking Vitreous Hemorrhage on Point-of-Care Ultrasound Following Blunt Ocular Trauma: A Case Report

Background. Ocular complaints account for approximately 1.5% of emergency department (ED) visits, and point-of-care ultrasound (POCUS) is a valuable tool for evaluating posterior chamber pathology, including vitreous hemorrhage (VH), retinal detachment, and vitreous detachment. However, benign conditions may mimic these pathologies and create diagnostic uncertainty. We describe a case of asteroid hyalosis (AH), a benign vitreous condition that was initially mistaken for vitreous hemorrhage on ocular POCUS following blunt ocular trauma. This case highlights an uncommon sonographic mimic of VH and contributes to the emergency medicine literature by emphasizing ultrasound features that may help distinguish AH from true posterior chamber pathology. Case. A 60-year-old female presented to the ED after an exercise band struck her left eye, causing pain, photophobia, blurred vision, and decreased visual acuity. Ocular POCUS demonstrated numerous hyperechoic vitreous opacities that were interpreted as vitreous hemorrhage. Ophthalmology was consulted and initially agreed that the sonographic findings were concerning for VH in the setting of trauma. However, subsequent dilated ophthalmologic examination revealed no vitreous hemorrhage. The patient was ultimately diagnosed with asteroid hyalosis, commotio retinae, traumatic iritis, and traumatic microhyphema. She was treated conservatively with topical medications and ophthalmology follow-up and recovered without complications. Conclusion. Asteroid hyalosis is a benign degenerative condition characterized by calcium-lipid deposits suspended within the vitreous humor that appear on ultrasound as numerous mobile hyperechoic foci and may mimic vitreous hemorrhage. Unlike VH, AH typically demonstrates multiple discrete spherical echogenic opacities distributed throughout the vitreous cavity, often producing a characteristic sparkling appearance with ocular movement. Recognition of AH as a benign sonographic mimic of VH may improve diagnostic accuracy, reduce unnecessary interventions and consultations, and support appropriate management of patients presenting with ocular trauma.