AVL: Retinal Detachment Flashcards
Retinal detachment: detachment of what?
Separation of the retinal neurosensory layer from the retinal pigment epithelium
Types of retinal detachment
- Rhegmatogenous
- Exudative
- Tractional
Rhegmatogenous retinal detachment
*Most common
Due to retinal break
- Tears developing in degenerate/thin neurosensory retina
- Tear enables fluid from synergetic vitreous to enter and cause separation between the neurosensory retina and the retinal pigment epithelium
Types of breaks in rhegmatogenous retinal detachment
Horseshoe/ U-shaped
Atrophic hole
Risk factors of rhegmatogenous retinal detachment
- High myopia
- Acute posterior vitreous detachment
- Increasing age (Degenerate vitreous which collapses with age)
- Trauma
- Retinal degeneration
- FHx
- Previous intraocular surgery
Symptoms of retinal detachment
4Fs
- Sudden onset or sudden increase in numbers of floaters
- Flashes of light
- Falling visual acuity
- Partial visual field defect (peripheral/central if macula affected)
“Curtain obscuring peripheral vision”
Signs of retinal detachment
+/- RAPD
Poor vision (VA decrease)
Visual field defect
Fundoscopy:
- Loss of red reflex
- Detached retina (Grey/ undulating)
Horseshoe/ U-shaped
Atrophic Hole
Possible outcomes of retinal detachment
- Progression to total RD
- Spontaneous re-attachment
- Rubeosis Iridis (Neovascularization of iris)
- Vitreous hemorrhage
- Phthisis Bulbi (Severely strophic, shrunken and soft eye)
- Permanent visual loss
Management of retinal detachment
Immediate:
- Bedrest
- Urgent listing and referral
- NBM in anticipation of retinal surgery
- Avoidance of pressure on globe
- Check other eye (Pathology should be bilateral)
Definitive:
1. Retinal detachment surgery
- Sealing retinal tears by scarring with cryo-application/ diathermy/ laser photocoagulation
*also for prophylactic use
- Scleral buckle
- Flattening retina
2. Intravitreal surgery (Vitrectomy + Gas Injection)
3. Pneumatic retinopexy
Exudative retinal detachment
Fluid accumulation in the subretinal space
- Due to inflammatory condition (severe uveitis, intraocular tumours)
Tractional retinal detachment
Pulling of neurosensory retinal away from retinal pigment epithelium in absence of tear
- Due to severe proliferative diabetic retinopathy
- New vessels grow below retina with fibrous proliferation, attachment to vitreous anteriorly causes detachment
Mx: Vitrectomy
??Definitive dx of retinal detachment
Indirect ophthalmoscope
What is pathognomonic of a retinal tear seen in indirect ophthalmoscope?
Shafer’s sign
- suspended pigment particles seen floating in the anterior vitreous
- “tobacco’s dust”
Posterior vitreous detachment
With age, vitreous liquefies and contracts in upon itself. If this occurs suddenly, the posterior vitreous face can suddenly peel off the retina causing separation of vitreous body from the retina
- 1 floater
- Regularly monitor patient for retinal tear which progresses to detachment
