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).
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).
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.
History and exam
Key diagnostic factors
- loss or deterioration of central vision
- flashes of light
- loss of peripheral visual field
Other diagnostic factors
- posterior vitreous detachment
- increasing age
- previous cataract surgery
- 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
1st investigations to order
- visual acuity testing
- slit-lamp exam
- indirect ophthalmoscopy
Investigations to consider
- wide-field color photography
- optical coherence tomography (affected eye)
- B-scan ultrasonography (affected eye)
- CT/MRI of orbit
posterior vitreous detachment without break/tear
retinal hole/tear without detachment
- Diabetic retinopathy
- Retinal vein occlusion
- Pediatric eye evaluations preferred practice pattern
- Comprehensive adult medical eye evaluation PPP 2020
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