During dilated examination of a patient with acute flashes and floaters, slit-lamp biomicroscopy with a 78 dioptre lens reveals fine brown pigment granules floating in the anterior vitreous. What is this finding called and what does it signify?

• A Asteroid hyalosis, indicating diabetes mellitus
• B Snowball opacities, indicating intermediate uveitis
• C Tobacco dust, indicating vitreous hemorrhage from proliferative retinopathy
• D Shafer sign, indicating a retinal break ✓

Explanation

Pigment granules liberated from the retinal pigment epithelium through a retinal break into the vitreous constitute Shafer sign, also called tobacco dust. It is highly specific for a retinal tear or break and mandates careful peripheral retinal search with scleral indentation even if no break is initially seen. Asteroid hyalosis consists of white calcium soap particles unrelated to breaks, snowballs are inflammatory aggregates in uveitis, and diffuse vitreous hemorrhage from PDR obscures rather than speckles the view.

Reference: Parsons' Diseases of the Eye, 23rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.