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For further information, see CMDT Part 7-14: Retinal Detachment

Key Features

Essentials of Diagnosis

  • Loss of vision in one eye that is usually rapid, possibly with "curtain" spreading across field of vision

  • No pain or redness

  • Detachment seen by ophthalmoscopy

General Considerations

  • Most cases are due to development of one or more peripheral retinal tears or holes (rhegmatogenous retinal detachment); this usually results from posterior vitreous detachment, related to degenerative changes in the vitreous

  • Generally occurs in persons over 50 years of age

  • Nearsightedness and cataract extraction are the two most common predisposing causes

  • May also be caused by penetrating or blunt ocular trauma

  • Once there is a defect in the retina, fluid vitreous is able to pass under the sensory retina and, with the added effects of vitreous traction and gravity, progressive retinal detachment results

  • Tractional retinal detachment occurs when there is preretinal fibrosis, such as in proliferative retinopathy due to diabetic retinopathy or retinal vein occlusion or as a complication of rhegmatogenous retinal detachment

  • Exudative retinal detachment results from accumulation of subretinal fluid, such as in wet ("neovascular") age-related macular degeneration or secondary to choroidal tumor

Clinical Findings

  • Rhegmatogenous retinal detachment usually starts in the superior temporal area, spreading rapidly to cause visual field loss that starts inferiorly and expands upward but can occur at other locations

  • Premonitory symptoms of the predisposing vitreous degeneration and vitreo-retinal traction include

    • Recent onset of or increase in floaters (moving spots or strands like cobwebs in the visual field)

    • Photopsias (flashes of light)

  • Central vision remains intact until the central macula becomes detached

Diagnosis

  • Retina may be elevated in the vitreous cavity with an irregular surface

  • One or more retinal tears or holes are usually found on retinal examination with scleral depression, which is a technique to examine the peripheral retina using a cotton tip swab or blunt instrument to push on, or depress, the external eye to evaluate the peripheral retina through a dilated pupil

  • A macular hole, usually caused by traction from the vitreous or scar tissue on the retinal surface (epiretinal membrane), causes reduction of central vision

  • In idiopathic cases, the hole occurs from localized retinal traction with retinal separation at the fovea, whereas in macular hole due to trauma or nearsightedness, there is a risk of progression to total retinal detachment

  • In tractional retinal detachment, there is irregular retinal elevation adherent to scar tissue on the retinal surface, sometimes extending into the vitreous

  • In exudative retinal detachment, the retina is dome-shaped and the subretinal fluid shifts position with changes in posture

  • Ocular ultrasonography assists the detection and characterization of retinal detachment

Treatment

  • Laser photocoagulation to the retina or cryotherapy to the sclera

    • Treats rhegmatogenous retinal detachments

    • Closes all of the ...

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