Retinal detachment: Difference between revisions

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==History ==
==Background==
# Abrupt onset of new "floaters" or flashes of light
[[File:A Retinal Detachment.jpg|thumb|Retinal detachement]]
# Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss
[[File:Ocular - Retinal detachment.gif|thumb]]
## May be mild or dramatic
*Average age of onset ~55
==DDx==
[[Acute Vision Loss]]


==Diagnosis==
===Types===
# Examination
#Rhegmatogenous (rhegma means "tear")
## Visual acuity and visual fields
#*As vitreous separates from retina the traction creates a hole in retina
## Intraocular pressure
#**Fluid goes through the hole and peels the retina off like wallpaper
### Hypotony of > 4-5 mmHg is common in the affected eye
#Exudative
## Fundoscopic exam with dilation
#*Fluid accumulates beneath the retina without a retinal tear
# Ultrasound
#*Associated with neoplasm, inflammatory conditions, [[hypertension]], [[preeclampsia]]
## Linear probe (7.5-10-MHz) is preferred
#Tractional
## Have pt lightly close their eye; avoid excessive pressure on globe
#*Acquired fibrocellular bands in the vitrous contract and detach the retina
#*Associated with [[DM]], [[sickle cell]], [[facial trauma|trauma]]
#Distinguish between mac-off and mac-on


==Disposition ==
===Other risk factors===
Urgent ophtho referral
*Aging
*Previous retinal detachment
*Family history of retinal detachment
*Extreme myopia
*Eye surgery, cataract removals


[[Category:Ophtho]]
==Clinical Features==
*Abrupt onset of new [[Acute onset flashers and floaters|"floaters" or flashes of light]]
**Vitreous tugs on the retina before separation
*[[vision loss|Visual acuity loss]] (filmy, cloudy, or curtain-like) or [[visual field defects|visual field]] loss
**May be mild or dramatic
*[[Fundoscopic exam]] with dilation
**On fundoscopy, elevated retina will appear hazy gray and out of focus
 
==Differential Diagnosis==
{{Acute vision loss noninflamed DDX}}
 
{{Acute onset flashers and floaters DDX}}
 
==Evaluation==
[[File:RetinalDetachment.jpeg|thumbnail]]
*[[Ocular ultrasound]] (LR+ 12, LR– 0.27)<ref>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.</ref>
**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<ref>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.</ref>
 
==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<ref>Gariano RF and Kim CH. Evaluation and Management of Suspected Retinal Detachment. Am Fam Physician. 2004 Apr 1;69(7):1691-1699.</ref>:
****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==
*[[Acute Onset Flashers and Floaters]]
*[[Ocular ultrasound]]
 
==References==
<references/>
 
[[Category:Ophthalmology]]

Latest revision as of 19:48, 20 February 2020

Background

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

Types

  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

Evaluation

RetinalDetachment.jpeg
  • 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]

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[3]:
        • 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

  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.
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