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7-14: Retinal Detachment

Jacque L. Duncan; Neeti B. Parikh; Gerami D. Seitzman

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 of retinal detachment are due to development of one or more peripheral retinal tears or holes (rhegmatogenous retinal detachment) (eFigure 7–38). This usually results from posterior vitreous detachment, related to degenerative changes in the vitreous, and generally occurs in persons over 50 years of age. Nearsightedness and cataract extraction are the two most common predisposing causes. It 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.

eFigure 7–38.

Rhegmatogenous retinal detachment. A: Ultra-widefield (Optomap) images of superior rhegmatogenous retinal detachment of the right eye before and after treatment. 1: Detached retina hanging down to almost obscure the optic disk (white outline arrow), large U-shaped (“horseshoe”) tear in the superior temporal retina (white solid arrow) and round retinal tear in the superior nasal retina (black solid arrow). 2: Retinal laser photocoagulation scars around large U-shaped (“horseshoe”) tear in the superior temporal retina (white solid arrow) and round retinal tear in the superior nasal retina (black solid arrow). (Used, with permission, from J Sherman and Optos plc.). B: Red-free image of retinal detachment due to giant retinal tear showing detached retina (white outline arrow), edge of giant retinal tear (white solid arrow), and exposed choroid (black solid arrow). (Used, with permission, from S Kiss and Optos plc.)

An image shows U-shaped tear in the superior temporal retina, round tear in superior nasal retina, and a hanging detached retina almost obscuring the optic disk. An image shows U-shaped tear in the superior temporal retina and round tear in superior nasal retina.
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An image shows U-shaped tear in the superior temporal retina, round tear in superior nasal retina, and a hanging detached retina almost obscuring the optic disk. An image shows U-shaped tear in the superior temporal retina and round tear in superior nasal retina.
An image shows U-shaped tear in the superior temporal retina, round tear in superior nasal retina, and a hanging detached retina almost obscuring the optic disk. An image shows U-shaped tear in the superior temporal retina and round tear in superior nasal retina.
View Full Size||Download Slide (.ppt)
An image shows U-shaped tear in the superior temporal retina, round tear in superior nasal retina, and a hanging detached retina almost obscuring the optic disk. An image shows U-shaped tear in the superior temporal retina and round tear in superior nasal retina.

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 (eFigure 7–39). Exudative retinal detachment results from accumulation of subretinal fluid, such as in neovascular age-related macular degeneration or secondary to choroidal tumor (eFigure 7–40).

eFigure 7–39.

Ultra-widefield (Optomap) image of tractional retinal detachment due to proliferative diabetic retinopathy with fibrovascular tissue predominantly along the superior temporal vascular arcade (white outline arrow) and involving the optic disk (solid white arrow). (Used, with permission, from J Sherman and Optos plc.)

An image shows fibrovascular tissue around the optic disk.
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An image shows fibrovascular tissue around the optic disk.
eFigure 7–40.

Choroidal melanoma (black outline arrow) with serous retinal detachment (white outline arrow). (Used, with permission, from S Kiss and Optos plc.)

An image shows chorodial melanoma adjacent to the optic disk and retinal detachment.
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An image shows chorodial melanoma adjacent to the optic disk and retinal detachment.

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 ...

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