Posterior vitreous detachment: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* Sudden onset of floaters (black spots, cobwebs) | * Sudden onset of [[floaters]] (black spots, cobwebs) | ||
* Flashes of light (photopsia), especially in peripheral vision | * [[Flashes of light]] ([[photopsia]]), especially in peripheral vision | ||
* A curtain or shadow in the visual field (if associated with retinal tear/detachment) | * A curtain or shadow in the visual field (if associated with retinal tear/detachment) | ||
* Blurred vision or mild visual disturbances | * Blurred vision or mild visual disturbances | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
* [[Retinal detachment]] | |||
* Retinal tear | |||
* [[Vitreous hemorrhage]] | |||
* [[Uveitis]] | |||
* [[Migraine headache|Ocular migraine]] | |||
* Intraocular foreign body | |||
{{Acute onset flashers and floaters DDX}} | {{Acute onset flashers and floaters DDX}} | ||
==Evaluation== | ==Evaluation== | ||
* | ===Workup=== | ||
* | * Detailed history (onset, nature of floaters/flashes, visual changes) | ||
** | * Visual acuity testing | ||
** | * Pupillary examination (look for afferent pupillary defect) | ||
* Dilated fundoscopic exam (to assess for retinal tear or detachment) | |||
* Slit-lamp exam with vitreous evaluation | |||
* B-scan ocular ultrasound if fundus not visible due to hemorrhage or opacity <ref> American Academy of Ophthalmology. Posterior Vitreous Detachment. Accessed April 2025. https://www.aao.org </ref> | |||
===Diagnosis=== | |||
* Clinical diagnosis based on symptoms and direct visualization of a detached posterior hyaloid membrane or Weiss ring on fundoscopic or slit-lamp exam | |||
* Confirm absence of retinal tear or detachment via dilated eye exam or imaging | |||
==Management== | ==Management== | ||
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==Management== | ==Management== | ||
Revision as of 20:12, 21 May 2025
Background
- A common age-related condition in which the vitreous gel that fills the eye separates from the retina.
- Separation of posterior vitreous from the retina, as a result of vitreous degeneration and shrinkage
- Usually benign, however in acute phase can occasionally lead to serious complications such as retinal tears or detachment [1].
- Prompt diagnosis and surgical treatment of retinal detachment can prevent impending vision loss or can restore vision
Risk factors
- Age (prevalence):
- 50-59 yrs = 24%
- 80-90 yrs = 87%
- Myopia
- Trauma
- Intraocular inflammation
- Ocular surgery[2]
Clinical Features
- Sudden onset of floaters (black spots, cobwebs)
- Flashes of light (photopsia), especially in peripheral vision
- A curtain or shadow in the visual field (if associated with retinal tear/detachment)
- Blurred vision or mild visual disturbances
- Often asymptomatic in early stages or in less dramatic detachments
Differential Diagnosis
- Retinal detachment
- Retinal tear
- Vitreous hemorrhage
- Uveitis
- Ocular migraine
- Intraocular foreign body
Acute onset flashers and floaters
- Ocular causes
- Floaters and/or flashes
- Posterior vitreous detachment
- Retinal tear or retinal detachment
- Posterior uveitis
- Predominantly floaters
- Vitreous hemorrhage secondary to proliferative retinopathy
- Sympathetic ophthalmia
- Predominantly flashes
- Oculodigital stimulation
- Rapid eye movements
- Neovascular age-related macular degeneration
- Floaters and/or flashes
- Non-ocular causes
- Intraocular foreign body
- Migraine aura (classic)
- Migraine aura (acephalgicmigraine)
- Occipital lobe disorders
- Postural hypotension
Evaluation
Workup
- Detailed history (onset, nature of floaters/flashes, visual changes)
- Visual acuity testing
- Pupillary examination (look for afferent pupillary defect)
- Dilated fundoscopic exam (to assess for retinal tear or detachment)
- Slit-lamp exam with vitreous evaluation
- B-scan ocular ultrasound if fundus not visible due to hemorrhage or opacity [3]
Diagnosis
- Clinical diagnosis based on symptoms and direct visualization of a detached posterior hyaloid membrane or Weiss ring on fundoscopic or slit-lamp exam
- Confirm absence of retinal tear or detachment via dilated eye exam or imaging
Management
Referral of patients with presumed posterior vitreous detachment
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See Also
External Links
References
- ↑ Foos RY, Wheeler NC. Posterior vitreous detachment. Ophthalmology. 1982;89(12):1502–1512.
- ↑ Byer, N. E. (1994). Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. Ophthalmology, 101(9), 1503–1513.
- ↑ American Academy of Ophthalmology. Posterior Vitreous Detachment. Accessed April 2025. https://www.aao.org
Management
- Uncomplicated PVD: No treatment required; reassure patient and educate on warning signs of retinal detachment
- With retinal tear or detachment: Urgent referral to ophthalmology; treatment may involve laser photocoagulation, cryotherapy, or surgical repair
- Monitor: Regular follow-up with eye exams over subsequent weeks
Disposition
- Discharge with precautions if no retinal pathology found; instruct to return immediately if new floaters, flashes, or curtain-like visual loss occurs
- Urgent referral to ophthalmology if retinal tear, detachment, or vitreous hemorrhage suspected