Posterior vitreous detachment

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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

  • Ocular causes
  • Nonocular causes
    • Migraine aura (classic)
    • Migraine aura (acephalgicmigraine)
    • Occipital lobe disorders
    • Postural hypotension

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