Retinal detachment: Difference between revisions
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== | ==Background== | ||
*Separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE) | |||
*'''Ophthalmologic emergency''' — requires urgent referral; macula-off detachments should be repaired within 24-72 hours | |||
*Three types: | |||
**Rhegmatogenous (most common) — tear/break allows vitreous fluid under retina | |||
**Tractional — fibrous bands pull retina (diabetic retinopathy, sickle cell) | |||
**Exudative — fluid accumulation without a break (inflammation, tumor) | |||
*Annual incidence: ~1 in 10,000<ref name="haimann">Haimann MH, et al. Epidemiology of retinal detachment. ''Arch Ophthalmol''. 1982;100(2):289-292. PMID 7065948.</ref> | |||
== | ==Risk Factors== | ||
* | *Myopia (nearsightedness) — strongest risk factor | ||
*Prior cataract surgery | |||
*Trauma (blunt or penetrating) | |||
*Family history of retinal detachment | |||
*Prior retinal detachment in fellow eye | |||
*Lattice degeneration | |||
*Age >50 (posterior vitreous detachment) | |||
[[Category: | ==Clinical Features== | ||
*Painless visual symptoms (pain suggests alternative diagnosis) | |||
*Photopsia — flashing lights (traction on retina) | |||
*Floaters — sudden onset or dramatic increase | |||
*Visual field deficit — described as a "curtain" or "shadow" moving across vision | |||
*Decreased visual acuity if macula involved (macula-off detachment) | |||
*Shafer sign (tobacco dust / pigment in anterior vitreous) is pathognomonic on slit lamp | |||
==Differential Diagnosis== | |||
*[[Posterior vitreous detachment]] (most common cause of flashes/floaters; benign) | |||
*[[Vitreous hemorrhage]] | |||
*[[Central retinal artery occlusion]] | |||
*[[Central retinal vein occlusion]] | |||
*[[Optic neuritis]] | |||
*[[Migraine]] with visual aura | |||
*[[Acute angle-closure glaucoma]] | |||
==Evaluation== | |||
*Bedside ocular ultrasound — high sensitivity (97%) for detecting retinal detachment<ref name="blaivas">Blaivas M, et al. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. ''Acad Emerg Med''. 2005;12(9):844-849. PMID 16141018.</ref> | |||
**Undulating membrane tethered to the optic disc (distinguishes from posterior vitreous detachment) | |||
*Fundoscopic exam: retinal elevation, tears, or folds | |||
**May be difficult to visualize in ED without pupil dilation | |||
*Visual acuity — document in all patients | |||
*Pupil exam — [[Relative afferent pupillary defect|APD]] may be present | |||
==Management== | |||
*Emergent ophthalmology consultation | |||
**Macula-on detachment: repair within 24 hours (to preserve central vision) | |||
**Macula-off detachment: repair within 24-72 hours; outcomes less time-sensitive | |||
*Restrict activity and avoid Valsalva maneuvers | |||
*If a superior detachment, position patient upright (to slow progression) | |||
*If inferior detachment, supine positioning | |||
*No specific ED treatment will reverse detachment — definitive repair is surgical | |||
*Surgical options (for ophthalmology): pneumatic retinopexy, scleral buckle, vitrectomy | |||
==Disposition== | |||
*Emergent ophthalmology referral for all suspected retinal detachments | |||
*Macula-on: same-day evaluation and likely same-day repair | |||
*Macula-off: urgent repair within days; outpatient if ophthalmology comfortable | |||
*Posterior vitreous detachment without retinal break: outpatient ophthalmology follow-up within 1-2 weeks | |||
==See Also== | |||
*[[Posterior vitreous detachment]] | |||
*[[Vitreous hemorrhage]] | |||
*[[Central retinal artery occlusion]] | |||
*[[Acute angle-closure glaucoma]] | |||
*[[Eye emergencies]] | |||
==References== | |||
<references/> | |||
[[Category:Ophthalmology]] | |||
Latest revision as of 09:36, 22 March 2026
Background
- Separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE)
- Ophthalmologic emergency — requires urgent referral; macula-off detachments should be repaired within 24-72 hours
- Three types:
- Rhegmatogenous (most common) — tear/break allows vitreous fluid under retina
- Tractional — fibrous bands pull retina (diabetic retinopathy, sickle cell)
- Exudative — fluid accumulation without a break (inflammation, tumor)
- Annual incidence: ~1 in 10,000[1]
Risk Factors
- Myopia (nearsightedness) — strongest risk factor
- Prior cataract surgery
- Trauma (blunt or penetrating)
- Family history of retinal detachment
- Prior retinal detachment in fellow eye
- Lattice degeneration
- Age >50 (posterior vitreous detachment)
Clinical Features
- Painless visual symptoms (pain suggests alternative diagnosis)
- Photopsia — flashing lights (traction on retina)
- Floaters — sudden onset or dramatic increase
- Visual field deficit — described as a "curtain" or "shadow" moving across vision
- Decreased visual acuity if macula involved (macula-off detachment)
- Shafer sign (tobacco dust / pigment in anterior vitreous) is pathognomonic on slit lamp
Differential Diagnosis
- Posterior vitreous detachment (most common cause of flashes/floaters; benign)
- Vitreous hemorrhage
- Central retinal artery occlusion
- Central retinal vein occlusion
- Optic neuritis
- Migraine with visual aura
- Acute angle-closure glaucoma
Evaluation
- Bedside ocular ultrasound — high sensitivity (97%) for detecting retinal detachment[2]
- Undulating membrane tethered to the optic disc (distinguishes from posterior vitreous detachment)
- Fundoscopic exam: retinal elevation, tears, or folds
- May be difficult to visualize in ED without pupil dilation
- Visual acuity — document in all patients
- Pupil exam — APD may be present
Management
- Emergent ophthalmology consultation
- Macula-on detachment: repair within 24 hours (to preserve central vision)
- Macula-off detachment: repair within 24-72 hours; outcomes less time-sensitive
- Restrict activity and avoid Valsalva maneuvers
- If a superior detachment, position patient upright (to slow progression)
- If inferior detachment, supine positioning
- No specific ED treatment will reverse detachment — definitive repair is surgical
- Surgical options (for ophthalmology): pneumatic retinopexy, scleral buckle, vitrectomy
Disposition
- Emergent ophthalmology referral for all suspected retinal detachments
- Macula-on: same-day evaluation and likely same-day repair
- Macula-off: urgent repair within days; outpatient if ophthalmology comfortable
- Posterior vitreous detachment without retinal break: outpatient ophthalmology follow-up within 1-2 weeks
See Also
- Posterior vitreous detachment
- Vitreous hemorrhage
- Central retinal artery occlusion
- Acute angle-closure glaucoma
- Eye emergencies
References
- ↑ Haimann MH, et al. Epidemiology of retinal detachment. Arch Ophthalmol. 1982;100(2):289-292. PMID 7065948.
- ↑ Blaivas M, et al. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-849. PMID 16141018.