Posterior vitreous detachment: Difference between revisions

(Text replacement - "==Diagnosis==" to "==Evaluation==")
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[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
==Background==
Posterior vitreous detachment (PVD) is a common age-related condition in which the vitreous gel that fills the eye separates from the retina. It typically occurs in individuals over age 50, with increasing prevalence in older populations and those with myopia or after eye surgery <ref> 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. </ref>. While usually benign, it can occasionally lead to serious complications such as retinal tears or detachment <ref> Foos RY, Wheeler NC. Posterior vitreous detachment. Ophthalmology. 1982;89(12):1502–1512. </ref>.
==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]]
* [[Migraine headache|Ocular migraine]]
* Intraocular foreign body
==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==
* 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
==See Also==
==External Links==
==References==
<references/>

Revision as of 20:02, 21 May 2025

Background

  • Separation of posterior vitreous from the retina, as a result of vitreous degeneration and shrinkage
  • Age-related event (prevalence):
    • 50-59 yrs = 24%
    • 80-90 yrs = 87
  • in the majority of cases PVD is benign
  • in acute phase, concern is for causing retinal tear, which can lead to retinal detachment
  • Prompt diagnosis and surgical treatment of retinal detachment can prevent impending vision loss or can restore vision

Risk factors

  • myopia
  • trauma
  • intraocular inflammation

Evaluation

Differential Diagnosis

Acute onset flashers and floaters

Management

Referral of patients with presumed posterior vitreous detachment

Clinical Assessment Disposition
  • Floaters and/or flashes with “red flag” sign of acute Retinal Detachment
    • Monocular visual field loss (“curtain of darkness”)
  • Same-day (immediate) referral to retinal surgeon (minutes may matter)
  • New-onset floaters and/or flashes with high-risk features:
    • Subjective or objective visual reduction examination
    • Vitreous hemorrhage or vitreous pigment on slitlamp examination
  • Same-day referral to ophthalmologist or retinal surgeon
  • New-onset floaters and/or flashes without high-risk features
  • Referral to ophthalmologist within 1 to 2 weeks
    • Counsel patient regarding high-risk features
  • Recently diagnosed uncomplicated posterior vitreous detachment with
    • New shower of floaters
    • New subjective visual reduction
  • Rereferral to ophthalmologist to rule out new retinal tear or detachment
    • Contact ophtho to help determine urgency
  • Stable symptoms of floaters and/or flashes for several weeks to months, not particularly bothersome to the patient and without high-risk features
  • Elective referral to ophthalmologist
    • Counsel patient regarding high-risk features that should prompt urgent reassessment

See Also

Acute Onset Flashers and Floaters

References


Background

Posterior vitreous detachment (PVD) is a common age-related condition in which the vitreous gel that fills the eye separates from the retina. It typically occurs in individuals over age 50, with increasing prevalence in older populations and those with myopia or after eye surgery [1]. While usually benign, it can occasionally lead to serious complications such as retinal tears or detachment [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

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

  • 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

See Also

External Links

References

  1. ↑ 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.
  2. ↑ Foos RY, Wheeler NC. Posterior vitreous detachment. Ophthalmology. 1982;89(12):1502–1512.
  3. ↑ American Academy of Ophthalmology. Posterior Vitreous Detachment. Accessed April 2025. https://www.aao.org
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