Posterior vitreous detachment: Difference between revisions
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*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>
*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>
==Clinical Features==
==Differential Diagnosis==
{{Acute onset flashers and floaters DDX}}


==Evaluation==
==Evaluation==
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**[[Floaters]]
**[[Floaters]]
**[[Flashes]]
**[[Flashes]]
==Differential Diagnosis==
{{Acute onset flashers and floaters DDX}}


==Management==
==Management==

Revision as of 20:07, 21 May 2025

Background

  • 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

Differential Diagnosis

Acute onset flashers and floaters

Evaluation

Management

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

Acute Onset Flashers and Floaters

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.


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

Evaluation

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 [1]

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

  • Uncomplicated PVD: No treatment required; reassure patient and educate on warning signs of retinal detachment
  • With retinal tear or detachment: Urgent referral to ophthalmology; treatment may involve laser photocoagulation, cryotherapy, or surgical repair
  • Monitor: Regular follow-up with eye exams over subsequent weeks

Disposition

  • Discharge with precautions if no retinal pathology found; instruct to return immediately if new floaters, flashes, or curtain-like visual loss occurs
  • Urgent referral to ophthalmology if retinal tear, detachment, or vitreous hemorrhage suspected

See Also

External Links

References

  1. ↑ American Academy of Ophthalmology. Posterior Vitreous Detachment. Accessed April 2025. https://www.aao.org
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