Retinal detachment

Background

1. Average age of onset ~55
2. Types
   1. Rhegmatogenous (rhegma means "tear")
      1. As vitreous separates from retina the traction creates a hole in retina
         1. Fluid goes through the hole and peels the retina off like wallpaper
   2. Exudative
      1. Fluid accumulates beneath the retina without a retinal tear
      2. Associated w/ neoplasm, inflammatory conditions, hypertension, preeclampsia
   3. Tractional
      1. Acquired fibrocellular bands in the vitrous contract and detach the retina
      2. Associated w/ DM, sickle cell, trauma

Clinical Features

1. Abrupt onset of new "floaters" or flashes of light
   1. Vitreous tugs on the retina before separation
2. Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss
   1. May be mild or dramatic

DDx

• Acute Vision Loss (Noninflamed)
• Acute Onset Flashers and Floaters

Diagnosis

1. Examination
   1. Visual acuity and visual fields
   2. Fundoscopic exam with dilation
2. Ultrasound
   1. Linear probe (7.5-10-MHz) is preferred
   2. Have pt lightly close their eye; avoid excessive pressure on globe

Treatment

• Urgent ophtho referral within 24hr
• In macular off retinal detachment, visual acute is significantly decreased if reattachment does not occur within 6 days.

See Also

Acute Onset Flashers and Floaters

Source

Tintinalli