6.1.12: Evaluates & manages pxs w/ sxs of retinal detachment Flashcards
Describe flashes and floaters?
o Flashes: Stimulation of the visual pathway usually occurring on eye movement.
o Floaters: Vitreous collagen aggregations, Weiss Ring, Haemorrhages, Retinal Debris.
Describe posterior vitreous detachment - sxs, signs?
The vitreous detaches from the retina (vitreous attached firmly at ora serrata and loosely at macula).
True PVD represents the separation of the cortical gel and the posterior hyaloid membrane from the retinal surface. Only true PVDs carry the risk of retinal tear.
PVDs occur due the contraction and constriction of the vitreous typically due to
liquification of the vitreous gel and collagen fibre matrix with time, but can also happen
as a result of trauma.
* Tears are present in 15% of symptomatic PVD
* If haemorrhages are present, there is a 70% chance of a tear
* Myopes have a higher chance of tear
Symptoms
* Px experiencing symptoms of flashing lights and floaters.
* Flashing light is dim white or golden arc in temporal periphery usually visible in
dim conditions
* Persisting flashing and increase in floaters suggest retinal traction.
Signs
* Weiss Ring (Maybe seen on ophthalmoscopy)
* Retinal Breaks
* Holes 14%,
* Horseshoe Tears 20%,
* Giant Tears 10%,
* 44% Retinal Dialyses
Describe retinal degeneration - benign causes and those predisposing to retinal detachment?
Retinal Degeneration - Benign
o Cystoid degeneration, Pavingstone degeneration, Reticular pigmentary degeneration, equatorial drusen
Retinal Degeneration
Often predispose an RD
* Lattice degeneration – retinal thinning and overlying vitreous liquification
* White without pressure – Areas of peripheral whitening on the retina seen
without scleral indentation. Caused by a changes in the vitreoretinal attachments
which result in retinal atrophy and abnormal vitreo-retinal adhesion
* Retinoschisis – splitting of the retina at the outer plexiform layer.
Describe exudative retinal detachment?
Occurs in the absence of a retinal break or vitreo-retinal traction, where exudation of
fluid into the retinal tissue plane leads to a retinal detachment.
Causes:
* Choroid tumour
* Inflammatory eye disease
* Central serous retinopathy
Describe rhegmatogenous retinal detachment?
Occurs as a result of a retinal break in the neurosensory retina
once a break occurs fluid can pass into subretinal space separating the neuro sensory
retina from RPE.
Describe tractional retinal detachment?
Occurs when retina separates from RPE due to tractional forces - scar tissue, other tissue or new BVs grow on retina & pull it away
Causes: diabetic retinopathy, RoP, BRVO
Hardest to treat “chewing gum on tissue paper”
What are the warning symptoms of retinal detachment?
o Vitreous pull may appear as flashes of light
o Floaters
o Grey Curtain moving across the visual field
What are the risk factors of retinal detachment?
o PVD
o Mod-high myopia
o Aged over 60
o Family History
o Trauma
o Retinal Tears
o Retinal degeneration
What are the indications of retinal break?
- Pigmented cells (Tobacco Dust) in the anterior vitreous on slit lamp BIO (Schaffer’s sign)
- Pigment in the fundus – Demarcation line
- Operculum in vitreous
What is the management of retinal detachment?
Any Px present with primary complaint of flashes and floaters is seen in which a thorough
dilated eye examination is carried out.
Emergency Referral
* RD with good VA (Macula On),
* Vitreous or pre-retinal haemorrhage,
* Pigment in anterior vitreous,
* Retinal Tear/Holes with symptoms
Urgent Referral
* RD with poor VA (Macula off) unless this is longstanding retinal hole/tear without
symptoms.
* Lattice degeneration with symptom of flashes and floaters
Discharge with Advice
* Uncomplicated PVD Advice – Explain diagnosis of PVD to Px with supporting material (PVD Leaflet).
* Explain to Px to return immediately if symptoms worsen (increase in floaters, veiling of vision) or go to A&E.
