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.
Most cases of retinal detachment are due to development of one or more peripheral retinal tears or holes (rhegmatogenous retinal detachment) (eFigure 7–40). 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.
Ultra-widefield (Optomap) images of superior rhegmatogenous retinal detachment of the right eye before and after treatment. A: 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). B: 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 S Kiss and Optos plc.)
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 7–40). Exudative retinal detachment results from accumulation of subretinal fluid, such as in neovascular age-related macular degeneration or secondary to choroidal tumor (eFigure 7–41).
Choroidal melanoma (black outline arrow) with serous retinal detachment (white outline arrow). (Used, with permission, from S Kiss and Optos plc.)
Rhegmatogenous retinal detachment usually starts in the peripheral retina, spreading rapidly to cause visual field loss (eFigure 7–40). 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) and photopsias (flashes of light). Central vision remains intact until the central macula becomes detached. On ophthalmoscopic examination, the retina may be seen elevated in the vitreous cavity with an irregular surface (Figure 7–1). One or more retinal tears or holes can usually be 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 ...