Retinal detachment

Last reviewed: September 2018

Last updated: August 2017

Summary

An acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium with accumulation of subretinal 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 exam. 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 subretinal 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.

Definition

Retinal detachment (RD) is typically a progressive condition in which the neuroretina separates (detaches) from the retinal pigment epithelium. Subretinal 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). [1] In the tractional form, RD is caused by proliferative membranes, whether present on the retinal surface or, less commonly, underneath it (subretinal 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 subretinal 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 hemorrhagic form, RD is caused by the accumulation of subretinal 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

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

Full details

Other diagnostic factors

floaters

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Risk factors

posterior vitreous detachment
increasing age
myopia exceeding -8 D
previous cataract surgery
trauma
ocular inflammation/infection
previous ophthalmic surgery
intraocular tumor
vitreous hemorrhage
affected fellow eye
diabetes mellitus
peripheral retinal degeneration
anatomic abnormality
age-related macular degeneration

Full details

Diagnostic investigations

1st investigations to order

visual acuity testing
slit-lamp exam
indirect ophthalmoscopy

Full details

Investigations to consider

B-scan ultrasonography of affected eye
CT/MRI of orbit

Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL 

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

Milos Klinika

Belgrade

Serbia

Consultant

Zagorskiego Klinik

Nałęczów/Rzeszów

Poland

Disclosures

FK declares that he has no competing interests.

Acknowledgements

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

Peer reviewers VIEW ALL 

David Steel, MBBS, FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

Disclosures

DS declares that he has no competing interests.

Michael W. Stewart, MD

Professor and Chairman of Ophthalmology

Mayo Clinic

Jacksonville

Disclosures

MWS declares that he has no competing interests.

Ron Adelman, MD, MPH, FACS

Associate Professor of Ophthalmology

Yale University School of Medicine

New Haven

Disclosures

RA declares that he has no competing interests.

Scott Fraser, MD, FRCS (Ed), FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

Disclosures

SF declares that he has no competing interests.

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Retinal detachment

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

posterior vitreous detachment without break/tear

retinal hole/tear without detachment

rhegmatogenous RD

tractional RD

exudative RD

hemorrhagic RD

Contributors

Authors VIEW ALL 

Ferenc Kuhn, MD, PhD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

David Steel, MBBS, FRCOphth

Disclosures

Michael W. Stewart, MD

Disclosures

Ron Adelman, MD, MPH, FACS

Disclosures

Scott Fraser, MD, FRCS (Ed), FRCOphth

Disclosures

Differentials

Guidelines

Patient leaflets

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