Retinal detachment is an acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium with accumulation of sub-retinal fluid and loss of retinal function.
May be primary (rhegmatogenous retinal detachment), secondary to traction, or exudative in nature.
In rhegmatogenous retinal detachment, retinal discontinuity promotes retinal detachment.
Diagnosis is by indirect ophthalmoscopy or slit-lamp examination. In case of media opacity, B-scan ultrasonography is necessary.
Left untreated, rhegmatogenous retinal detachment typically results in blindness.
Surgical treatment is aimed at preventing fluid access to the sub-retinal space through the break and eliminating the traction causing the break.
If treated, prognosis is generally good. The most common cause of failure is scarring due to proliferative vitreoretinopathy.
Retinal detachment (RD) is typically a progressive condition in which the neuroretina separates (detaches) from the retinal pigment epithelium. Sub-retinal fluid accumulates, and the retina temporarily loses its function. In case of a rhegmatogenous RD, the separation is due to a retinal discontinuity (break, tear). In the tractional form, RD is caused by proliferative membranes, whether present on the retinal surface or, less commonly, underneath it (sub-retinal strands). No retinal break is present, although it may subsequently develop (combined rhegmatogenous/tractional RD). Similarly, rhegmatogenous RD may develop a secondary tractional element. In the serous form, RD is caused by the sub-retinal accumulation of fluid, other than that originating in the vitreous cavity, caused by leaking retinal blood vessels or discontinuities in the retinal pigment epithelium. In the haemorrhagic form, RD is caused by the accumulation of sub-retinal blood, most commonly due to trauma. Retinoschisis is not an RD in the true sense of the word; here layers of the neuroretina split, and the fluid is between layers of the neuroretina. Full thickness retinal detachment can rarely complicate retinoschisis.
History and exam
Key diagnostic factors
- presence of risk factors
- loss or deterioration of central vision
- flashes of light
- loss of peripheral visual field
Other diagnostic factors
- posterior vitreous detachment
- increasing age
- myopia exceeding -8 D
- previous cataract surgery
- ocular inflammation/infection
- previous ophthalmic surgery
- intraocular tumour
- vitreous haemorrhage
- affected fellow eye
- diabetes mellitus
- peripheral retinal degeneration
- anatomical abnormality
- age-related macular degeneration
1st investigations to order
- visual acuity testing
- slit-lamp examination
- indirect ophthalmoscopy
Investigations to consider
- B-scan ultrasonography of affected eye
- CT/MRI of orbit
posterior vitreous detachment without break/tear
retinal hole/tear without detachment
- Diabetic retinopathy
- Retinal vein occlusion
- Posterior vitreous detachment, retinal breaks, and lattice degeneration preferred practice pattern®
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