hellp syndrome represents a severe form of preeclampsia , presenting with hemolysis , elevated liver enzymes , and low platelet count .
visual symptoms can be present in up to 25% of patients with preeclampsia , usually in the form of decreased visual acuity .
retinal detachment is a rare , but the well - document cause of visual loss in patients with preeclampsia and eclampsia .
it is observed in < 1% of patients with preeclampsia , specially in the patients with severe hypertension . in women with preeclampsia and eclampsia , coexistence of hellp syndrome
point - of - care ocular ultrasonography allows for bedside detection of ocular pathologies such as retinal detachment , globe rupture , lens dislocation , and vitreous hemorrhage . here
, we report a case or retinal detachment in a patient with hellp syndrome , which was detected at the bedside by an intensivist , using ocular ultrasonography .
a 26-year - old female , para 2 and gravida 3 , presented with the history of 2 days of swelling of whole body , headache , and blurring of vision associated with decreased urine output .
her liver enzymes and lactate dehydrogenase were raised , platelet count was 55,000 per ml , and urine examination revealed 4 plus albuminuria and hematuria .
emergency lower segment cesarean section was performed , and the patient was transferred to the intensive care unit .
an intensivist , trained in bedside focused ultrasonography , performed ocular ultrasound ( using high frequency linear probe ; frequency range of 613 mhz ; micromaxx ; sonosite , usa ) , which revealed a linear hyperechoic membrane floating off the posterior globe , with the medial end attached to the margin of optic nerve head , which was suggestive of retinal detachment [ figure 1 ] .
she was started on injection glyceryl trinitrate , along with amlodipine 10 mg 12 hourly , prazosin 2.5 mg 12 hourly , metoprolol 50 mg 12 hourly , clonidine 100 mcg 12 hourly , and methyldopa 500 mg 6 hourly . with these drug combinations ,
blood pressure was controlled ( 130/80 mm hg ) and glyceryl trinitrate was tapered and stopped after 24 h. the patient underwent four sessions of hemodialysis for acute kidney injury .
renal function and liver function gradually improved . a linear hyperechoic membrane floating off the posterior globe ( marked by white arrow ) , with the medial end attached to the margin of optic nerve head , suggestive of retinal detachment the patient was explained about the favorable prognosis . with the supportive care ,
ocular ultrasound repeated after 7 days showed regression of retinal detachment [ figure 2 ] .
after another 1 week , she had complete recovery of vision . resolving retinal detachment ( marked by white arrow )
. retinal vascular changes , usually in the form of spasm and narrowing of retinal vessels , occur in up to 40%100% of patients with preeclampsia / eclampsia syndrome .
arteriolar vasospasm affecting the retinal pigment epithelium leads to breakdown of blood - retinal barrier .
subsequent leakage of protein and fluids from the capillaries , into the subretinal space , causes retinal detachment .
the combination of microangiopathic hemolysis , hypoalbuminemia , and severe hypertension further contributes to the pathophysiology of retinal detachment .
bedside ultrasound by a trained physician has been shown to be reliable and accurate for the diagnosis of retinal detachment .
. the incidence of retinal detachment in these conditions can be much higher than actually detected . in our patient ,
early initiation of aggressive supportive care was coupled with favorable prognostication of visual outcome to the patient .
the progressive improvement of vision correlated with both the ophthalmoscopic evidence of resolution of retinal detachment and sonographic appearance of resolution .
to conclude , bedside ocular sonography can be a valuable and easily available tool for early detection of retinal detachment in patients with preeclampsia / eclampsia / hellp syndrome , presenting with visual symptoms .
 retinal detachment is a rare , but well - known cause of visual impairment in patients with hemolysis , elevated liver enzymes , and low platelet count ( hellp ) syndrome . with supportive care , 
 patients usually improve , with complete recovery of vision . 
 bedside ultrasonography of the orbit can be helpful for early detection of retinal detachment in these patients . here , we present a case of hellp syndrome presenting with severe visual symptoms . 
 retinal detachment was detected with point - of - care ocular sonography , which was confirmed with ophthalmoscopic examination . 
 the patient was reassured of the favorable prognosis . 
 early initiation of aggressive supportive care was followed by progressive improvement of vision , which correlated with sonographic evidence of resolution of detachment . 
 her vision recovered completely in 2 weeks . 
Introduction
Case Report
Discussion
Conclusion
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