Posterior vitreous detachment: Difference between revisions
 
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==Background==
==Background==
*Separation of posterior vitreous from the retina, as a result of vitreous degeneration
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
and shrinkage
*A common age-related condition in which the vitreous gel that fills the eye separates from the retina.
*Age-related event (prevalence):
*Separation of posterior vitreous from the retina, as a result of vitreous degeneration and shrinkage
*Usually benign, however in acute phase can occasionally lead to serious complications such as retinal tears or detachment <ref> Foos RY, Wheeler NC. Posterior vitreous detachment. Ophthalmology. 1982;89(12):1502–1512. </ref>.
**Prompt diagnosis and surgical treatment of retinal detachment can prevent impending vision loss or can restore vision
 
===Risk factors===
*Age (prevalence):
**50-59 yrs = 24%
**50-59 yrs = 24%
**80-90 yrs = 87
**80-90 yrs = 87%
*Risk factors
*Myopia
**myopia
*Trauma
**trauma
*Intraocular inflammation
**intraocular inflammation
*Ocular surgery<ref> Byer, N. E. (1994). Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. Ophthalmology, 101(9), 1503–1513. </ref>
*in the majority of cases PVD is benign
 
*in acute phase, concern is for causing retinal tear, which can lead to retinal detachment
==Clinical Features==
*Prompt diagnosis and surgical treatment of retinal detachment can prevent impending
* Sudden onset of [[floaters]] (black spots, cobwebs)
vision loss or can restore vision
* [[Flashes of light]] ([[photopsia]]), especially in peripheral vision
* A curtain or shadow in the visual field (if associated with retinal tear/detachment)
* Blurred vision or mild visual disturbances
* Often asymptomatic in early stages or in less dramatic detachments
 
==Differential Diagnosis==
{{Acute onset flashers and floaters DDX}}
 
==Evaluation==
[[File:Vitreous Floaters.jpg|thumb|[[Fundoscopic exam]] showing a Weiss ring: a large, ring shaped floater that is sometimes seen if the vitreous body releases from the back of the eye.]]
===Workup===
* Detailed history (onset, nature of floaters/flashes, visual changes)
* Visual acuity testing
* Pupillary examination (look for afferent pupillary defect)
* Dilated fundoscopic exam (to assess for retinal tear or detachment)
* Slit-lamp exam with vitreous evaluation
* B-scan [[ocular ultrasound]] if fundus not visible due to hemorrhage or opacity <ref> American Academy of Ophthalmology. Posterior Vitreous Detachment. Accessed April 2025. https://www.aao.org </ref>
 
===Diagnosis===
* Clinical diagnosis based on symptoms and direct visualization of a detached posterior hyaloid membrane or Weiss ring on fundoscopic or slit-lamp exam
* Confirm absence of retinal tear or detachment via dilated eye exam or imaging
 
==Management==
*See disposition chart below
*No specific ED; focus of care is in determination of rapidity of ophthalmologic evaluation


==Diagnosis==
==Disposition==
*May be asymptomatic
{{Presumed posterior vitreous detachment management}}
*More frequently:
**[[Floaters]]
**[[Flashes]]


==See Also==
==See Also==
[[Acute Onset Flashers and Floaters]]
*[[Acute Onset Flashers and Floaters]]
 
==External Links==
 
==References==
<references/>


==Source==
[[Category:Ophthalmology]]

Latest revision as of 21:28, 30 July 2025

Background

Eye anatomy.
  • A common age-related condition in which the vitreous gel that fills the eye separates from the retina.
  • Separation of posterior vitreous from the retina, as a result of vitreous degeneration and shrinkage
  • Usually benign, however in acute phase can occasionally lead to serious complications such as retinal tears or detachment [1].
    • Prompt diagnosis and surgical treatment of retinal detachment can prevent impending vision loss or can restore vision

Risk factors

  • Age (prevalence):
    • 50-59 yrs = 24%
    • 80-90 yrs = 87%
  • Myopia
  • Trauma
  • Intraocular inflammation
  • Ocular surgery[2]

Clinical Features

  • Sudden onset of floaters (black spots, cobwebs)
  • Flashes of light (photopsia), especially in peripheral vision
  • A curtain or shadow in the visual field (if associated with retinal tear/detachment)
  • Blurred vision or mild visual disturbances
  • Often asymptomatic in early stages or in less dramatic detachments

Differential Diagnosis

Acute onset flashers and floaters

Evaluation

Fundoscopic exam showing a Weiss ring: a large, ring shaped floater that is sometimes seen if the vitreous body releases from the back of the eye.

Workup

  • Detailed history (onset, nature of floaters/flashes, visual changes)
  • Visual acuity testing
  • Pupillary examination (look for afferent pupillary defect)
  • Dilated fundoscopic exam (to assess for retinal tear or detachment)
  • Slit-lamp exam with vitreous evaluation
  • B-scan ocular ultrasound if fundus not visible due to hemorrhage or opacity [3]

Diagnosis

  • Clinical diagnosis based on symptoms and direct visualization of a detached posterior hyaloid membrane or Weiss ring on fundoscopic or slit-lamp exam
  • Confirm absence of retinal tear or detachment via dilated eye exam or imaging

Management

  • See disposition chart below
  • No specific ED; focus of care is in determination of rapidity of ophthalmologic evaluation

Disposition

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

External Links

References

  1. ↑ Foos RY, Wheeler NC. Posterior vitreous detachment. Ophthalmology. 1982;89(12):1502–1512.
  2. ↑ Byer, N. E. (1994). Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. Ophthalmology, 101(9), 1503–1513.
  3. ↑ American Academy of Ophthalmology. Posterior Vitreous Detachment. Accessed April 2025. https://www.aao.org
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