A 54-year-old diabetic presents with new floaters. Why?

Tip #195


This is a vertical image of the patient’s right eye. There is separation of the internal limiting membrane (ILM) from the nerve fiber layer. Between these two layers, there is a significant amount of speckled hyper reflectivity. There is also some intraretinal fluid in the superficial layers of the retina.

This patient was diagnosed with a sub ILM hemorrhage secondary to proliferative retinopathy.

In this tip's accompanying 10 min. video, we'll review:

  • Layers of the retina in which hemorrhage can be located
  • Causes of floaters
  • Common conditions that can present with proliferative retinopathy
Tip #195 Analysis


In a patient with hyper reflectivity anterior to the retina, think of hemorrhage in the vitreous, preretinal (subhyaloid) or sub ILM space.

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