Retinal detachment: Difference between revisions
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**Vitreous tugs on the retina before separation | **Vitreous tugs on the retina before separation | ||
*Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss | *Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss | ||
**May be mild or dramatic | **May be mild or dramatic | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Acute vision loss noninflamed DDX}} | {{Acute vision loss noninflamed DDX}} | ||
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**Visual acuity and visual fields | **Visual acuity and visual fields | ||
**Fundoscopic exam with dilation | **Fundoscopic exam with dilation | ||
**On fundoscopy, elevated retina will appear hazy gray and out of focus | |||
*Ocular ultrasound | *Ocular ultrasound | ||
**Generally remains anchored to the optic disc in most posterior section of the eye | **Generally remains anchored to the optic disc in most posterior section of the eye | ||
| Line 56: | Line 57: | ||
==Disposition== | ==Disposition== | ||
* | *Most likely admit vs same-day (immediate) referral to retinal surgeon (minutes may matter) | ||
==See Also== | ==See Also== | ||
Revision as of 22:47, 10 October 2018
Background
- Average age of onset ~55
Types
- 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
- As vitreous separates from retina the traction creates a hole in retina
- Exudative
- Fluid accumulates beneath the retina without a retinal tear
- Associated with neoplasm, inflammatory conditions, hypertension, preeclampsia
- Tractional
- Acquired fibrocellular bands in the vitrous contract and detach the retina
- Associated with DM, sickle cell, trauma
- 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)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
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
- Nonocular causes
- Migraine aura (classic)
- Migraine aura (acephalgicmigraine)
- Occipital lobe disorders
- Postural hypotension
Evaluation
- Examination
- Visual acuity and visual fields
- Fundoscopic exam with dilation
- On fundoscopy, elevated retina will appear hazy gray and out of focus
- Ocular ultrasound
- Generally remains anchored to the optic disc in most posterior section of the eye
- Appears as a hyperechoic membrane floating in the vitreous chamber
Management
- 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[1]:
- Superior detachment may have inferior visual field defect
- Temporal detachment may have nasal visual field defect
Disposition
- Most likely admit vs same-day (immediate) referral to retinal surgeon (minutes may matter)
See Also
References
- ↑ Gariano RF and Kim CH. Evaluation and Management of Suspected Retinal Detachment. Am Fam Physician. 2004 Apr 1;69(7):1691-1699.