A 65-year-old male with complex medical history including CHF, ESRD, T2DM, HTN presented with painless left eye vision loss for 3 days. Despite recent ophthalmologist consultation for prescribed glasses, symptoms presisted.

POCUS was performed in the setting of significant left eye decreased visual acuity without other significant findings on physician examination. Ultrasonography revealed swirling, mixed echogenic material suggestive of vitreous hemorrhage versus asteroid hyalosis. Asteroid hyalosis is a unique sonographic finding with a “starry sky” appearance similar to vitreous hemorrhage that is ultimately a benign vitreous condition resulting in calcium phospholipid deposits within the posterior chamber. Urgent ophthalmologic evaluation diagnosed both asteroid hyalosis and pre retinal macular hemorrhage, prompting referral to a retina specialist for pan retinal photocoagulation. This case underscores the importance of routine sonographic assessment in undifferentiated visual loss and highlights the importance of understanding benign versus emergency sonographic pathology that should be referred for prompt targeted ophthalmologic intervention.