Retinal detachment


Retinal detachement
Ocular - Retinal detachment.gif
  • Average age of onset ~55


  1. 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
  2. Exudative
    • Fluid accumulates beneath the retina without a retinal tear
    • Associated with neoplasm, inflammatory conditions, hypertension, preeclampsia
  3. Tractional
    • Acquired fibrocellular bands in the vitrous contract and detach the retina
    • Associated with DM, sickle cell, trauma
  4. 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

Differential Diagnosis

Acute Vision Loss (Noninflamed)

Emergent Diagnosis

Acute onset flashers and floaters


  • Ocular ultrasound (LR+ 12, LR– 0.27)[1]
    • Generally remains anchored to the optic disc in most posterior section of the eye
    • Appears as a hyperechoic membrane floating in the vitreous chamber
  • There are many studies out there confirming high sensitivity/specificity, recent study showing 94% sensitive/96% specific when performed by radiology and 92% sensitive/91% specific when performed by emergency providers[2]


  • 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[3]:
        • Superior detachment may have inferior visual field defect
        • Temporal detachment may have nasal visual field defect


  • Most likely admit vs same-day (immediate) referral to retinal surgeon (minutes may matter)

See Also


  1. Kim DJ, Francispragasam M, Docherty G, et al. Test Characteristics of Point-of-care Ultrasound for the Diagnosis of Retinal Detachment in the Emergency Department. Acad Emerg Med. 2019;26(1):16-22.
  2. Point-of-care ocular ultrasound for the diagnosis of retinal detachment: a systematic review and meta-analysis Gottlieb M, Holladay D, Peksa GD. Acad Emerg Med. 2019;26(8):931-939.
  3. Gariano RF and Kim CH. Evaluation and Management of Suspected Retinal Detachment. Am Fam Physician. 2004 Apr 1;69(7):1691-1699.