Retinal detachment

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Retinal detachement
Ocular - Retinal detachment.gif
  • Average age of onset ~55


  1. Rhegmatogenous (rhegma means "tear")
    • As vitreous separates from retina the traction creates a hole in retina
      • Fluid goes through the hole and peels the retina off like wallpaper
  2. Exudative
    • Fluid accumulates beneath the retina without a retinal tear
    • Associated with neoplasm, inflammatory conditions, hypertension, preeclampsia
  3. Tractional
    • Acquired fibrocellular bands in the vitrous contract and detach the retina
    • Associated with DM, sickle cell, trauma
  4. Distinguish between mac-off and mac-on
  • Other risk factors:
    • Aging
    • Previous retinal detachment
    • Family history of retinal detachment
    • Extreme myopia
    • Eye surgery, cataract removals

Clinical Features

  • Abrupt onset of new "floaters" or flashes of light
    • Vitreous tugs on the retina before separation
  • Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss
    • May be mild or dramatic

Differential Diagnosis

Acute Vision Loss (Noninflamed)

Emergent Diagnosis

Acute onset flashers and floaters


  • Examination
    • Visual acuity and visual fields
    • Fundoscopic exam with dilation
  • [Ocular ultrasound]]


  • Urgent ophtho referral within 24hr (pneumatic retinopexy, scleral buckle, or vitrectomy)[1]
  • In macular off retinal detachment, visual acute is significantly decreased if reattachment does not occur within 6 days. [2]
  • Position patient relative to area of retinal detachment so retina lies flat:
    • Superior detachment = lay patient's head in supine position
    • Inferior detachment = elevate head up
    • Different from face-down recovery position after pneumatic retinopexy (so that bubble covers retinal break)
    • May know where retinal detachment is by a couple of clues:
      • Good fundoscopy
      • US beam orientation
      • Visual Field Defects examples[3]:
        • Superior detachment may have inferior visual field defect
        • Temporal detachment may have nasal visual field defect

See Also


  1. Illinois Retina and Eye Associates. Retinal Detachment. 2009.
  2. Diederen R et al: Scleral buckling surgery after macula-off retinal detachment: Worse visual outcome after more than 6 days. Ophthalmology 2007; 114:705-709
  3. Gariano RF and Kim CH. Evaluation and Management of Suspected Retinal Detachment. Am Fam Physician. 2004 Apr 1;69(7):1691-1699.