Retinal detachment: Difference between revisions
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***Good fundoscopy | ***Good fundoscopy | ||
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***[[Visual | ***[[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 | ****Superior detachment may have inferior visual field defect | ||
****Temporal detachment may have nasal visual field defect | ****Temporal detachment may have nasal visual field defect | ||
Revision as of 08:24, 2 February 2016
Background
- Average age of onset ~55
Types
- 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
- As vitreous separates from retina the traction creates a hole in retina
- Exudative
- Fluid accumulates beneath the retina without a retinal tear
- Associated w/ neoplasm, inflammatory conditions, hypertension, preeclampsia
- Tractional
- Acquired fibrocellular bands in the vitrous contract and detach the retina
- Associated w/ DM, sickle cell, trauma
- Distinguish between mac-off and mac-on
- Other risk factors:
- Aging
- Previous retinal detachment
- Family hx of retinal detachment
- Extreme myopia
- Eye surgery, cataract removals
Clinical Features
- Abrupt onset of new "floaters" or flashes of light
- Vitreous tugs on the retina before separation
- Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss
- May be mild or dramatic
Differential Diagnosis
Acute Vision Loss (Noninflamed)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
Acute onset flashers and floaters
- Ocular causes
- Floaters and/or flashes
- Posterior vitreous detachment
- Retinal tear or retinal detachment
- Posterior uveitis
- Predominantly floaters
- Vitreous hemorrhage secondary to proliferative retinopathy
- Sympathetic ophthalmia
- Predominantly flashes
- Oculodigital stimulation
- Rapid eye movements
- Neovascular age-related macular degeneration
- Floaters and/or flashes
- Non-ocular causes
- Intraocular foreign body
- Migraine aura (classic)
- Migraine aura (acephalgicmigraine)
- Occipital lobe disorders
- Postural hypotension
Diagnosis
- Examination
- Visual acuity and visual fields
- Fundoscopic exam with dilation
- Ultrasound
Treatment
- Urgent ophtho referral within 24hr (pneumatic retinopexy, scleral buckle, or vitrectomy)[1]
- In macular off retinal detachment, visual acute is significantly decreased if reattachment does not occur within 6 days. [2]
- Position pt relative to area of retinal detachment so retina lies flat:
- Superior detachment = lay pt'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
See Also
Source
- ↑ Illinois Retina and Eye Associates. Retinal Detachment. 2009. http://www.illinoisretinainstitute.com/index.php?p=1_11.
- ↑ Diederen R et al: Scleral buckling surgery after macula-off retinal detachment: Worse visual outcome after more than 6 days. Ophthalmology 2007; 114:705-709
- ↑ Gariano RF and Kim CH. Evaluation and Management of Suspected Retinal Detachment. Am Fam Physician. 2004 Apr 1;69(7):1691-1699.