Retinal detachment

Background

Retinal detachement

1. Average age of onset ~55
2. Types
   1. Rhegmatogenous (rhegma means "tear")
      1. As vitreous separates from retina the traction creates a hole in retina
         1. Fluid goes through the hole and peels the retina off like wallpaper
   2. Exudative
      1. Fluid accumulates beneath the retina without a retinal tear
      2. Associated w/ neoplasm, inflammatory conditions, hypertension, preeclampsia
   3. Tractional
      1. Acquired fibrocellular bands in the vitrous contract and detach the retina
      2. Associated w/ DM, sickle cell, trauma
3. Distinguish between mac-off and mac-on

Clinical Features

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

DDx

• Acute Vision Loss (Noninflamed)
• Acute Onset Flashers and Floaters

Diagnosis

1. Examination
   1. Visual acuity and visual fields
   2. Fundoscopic exam with dilation
2. Ultrasound

Treatment

• Urgent ophtho referral within 24hr
• In macular off retinal detachment, visual acute is significantly decreased if reattachment does not occur within 6 days.

See Also

Acute Onset Flashers and Floaters

Source

Tintinalli