Retinal detachment

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Teoría 
Diagnóstico 
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Última revisão: 24 Sep 2025

Última atualização: 24 Jul 2025

Retinal detachment (RD) is an acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium, subretinal fluid accumulates, and retinal function is lost.

Presents as primary rhegmatogenous RD, secondary to traction, or exudative in nature.

In rhegmatogenous RD, retinal discontinuity promotes detachment.

Diagnosis usually relies on indirect ophthalmoscopy or slit-lamp exam, with B-scan ultrasonography reserved for cases with media opacity.

Left untreated, rhegmatogenous RD typically results in blindness.

Surgical treatment aims to prevent fluid accessing the subretinal space through the break and to eliminate the traction that caused the break.

If treated promptly, prognosis is generally good. Failure occurs in cases with scarring due to proliferative vitreoretinopathy (PVR).

Definição

RD is typically a progressive condition in which the neuroretina detaches from the retinal pigment epithelium. Subretinal fluid accumulates, causing temporary loss of retinal function.

In rhegmatogenous RD, the separation results from a retinal discontinuity (break, tear).[1]

Tractional RD occurs due to proliferative membranes on, or less commonly underneath, the retinal surface (subretinal strands). This usually occurs without a retinal break, although one may develop to cause a combined rhegmatogenous/tractional RD. Similarly, rhegmatogenous RD may develop a secondary tractional element.

Exudative RD develops due to the subretinal accumulation of fluid, other than that originating in the vitreous cavity. Leaking retinal blood vessels or discontinuities in the retinal pigment epithelium are the usual cause, with hemorrhagic RD mostly observed after trauma.

Retinoschisis does not qualify as a true RD because layers of the neuroretina split and fluid enters the space created. Full thickness RD can rarely complicate retinoschisis.

História e exame físico

Principais fatores diagnósticos

loss or deterioration of central vision
flashes of light
loss of peripheral visual field

Detalhes completos

Outros fatores diagnósticos

floaters

Detalhes completos

Fatores de risco

posterior vitreous detachment
increasing age
myopia
previous cataract surgery
trauma
previous ophthalmic surgery
intraocular tumor
vitreous hemorrhage
affected fellow eye
diabetes mellitus
retinopathy of prematurity
ocular inflammation/infection
peripheral retinal degeneration
anatomic abnormality
age-related macular degeneration
phosphodiesterase-5 inhibitor use in men
genetic and vascular causes in childhood
childhood tumors

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

visual acuity testing
slit-lamp exam
indirect ophthalmoscopy

Detalhes completos

Investigações a serem consideradas

wide-field color photography
optical coherence tomography (affected eye)
B-scan ultrasonography (affected eye)
CT/MRI of orbit

Detalhes completos

Algoritmo de tratamento

AGUDA

posterior vitreous detachment without break/tear

retinal hole/tear without detachment

rhegmatogenous RD

tractional RD

exudative RD

hemorrhagic RD

Colaboradores

Autores

Ferenc Kuhn, MD, PhD

Director of Clinical Research

Helen Keller Foundation for Research and Education

Associate Professor of Ophthalmology

University of Alabama at Birmingham

Birmingham

Consultant and Chief Vitreoretinal Surgeon

Department of Ophthalmology

University of Pécs Medical School

Pécs

Hungary

Declarações

FK declares that he has no competing interests.

Agradecimentos

Dr Kuhn would like to gratefully acknowledge Dr Robert Morris, a previous contributor to this monograph. RM declares that he has no competing interests.

Revisores

David Steel, MBBS, FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

Declarações

DS declares that he has no competing interests.

Michael W. Stewart, MD

Professor and Chairman of Ophthalmology

Mayo Clinic

Jacksonville

Declarações

MWS declares that he has no competing interests.

Ron Adelman, MD, MPH, FACS

Associate Professor of Ophthalmology

Yale University School of Medicine

New Haven

Declarações

RA declares that he has no competing interests.

Scott Fraser, MD, FRCS (Ed), FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

Declarações

SF declares that he has no competing interests.

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Principais artigos

Kim SJ, Bailey ST, Kovach JL, et al. Posterior vitreous detachment, retinal breaks, and lattice degeneration preferred practice pattern®. Ophthalmology. 2025 Apr;132(4):P163-96.Texto completo

American Academy of Ophthalmology. Referral of persons with possible eye diseases or injury - 2014. Apr 2014 [internet publication].Texto completo

Hikichi T, Trempe CL. Relationship between floaters, light flashes, or both, and complications of posterior vitreous detachment. Am J Ophthalmol. 1994;117:593-8. Resumo

Znaor L, Medic A, Binder S, et al. Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev. 2019 Mar 8;(3):CD009562.Texto completo Resumo

Sena DF, Kilian R, Liu SH, et al. Pneumatic retinopexy versus scleral buckle for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev. 2021 Nov 11;(11):CD008350.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Vitreomacular traction
- Retinoschisis
- Diabetic retinopathy
Mais Diagnósticos diferenciais
Diretrizes
- Posterior vitreous detachment, retinal breaks, and lattice degeneration preferred practice pattern®
- Retina summary benchmarks - 2024
Mais Diretrizes
Folhetos informativos para os pacientes
Macular degeneration
Mais Folhetos informativos para os pacientes
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Retinal detachment

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

posterior vitreous detachment without break/tear

retinal hole/tear without detachment

rhegmatogenous RD

tractional RD

exudative RD

hemorrhagic RD

Colaboradores

Autores

Ferenc Kuhn, MD, PhD

Declarações

Agradecimentos

Revisores

David Steel, MBBS, FRCOphth

Declarações

Michael W. Stewart, MD

Declarações

Ron Adelman, MD, MPH, FACS

Declarações

Scott Fraser, MD, FRCS (Ed), FRCOphth

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice