Detachment Flashcards
What is retinal detachment
Retina separates from the choroid underneath
What is the usual cause of retinal detachment
Usually due to retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and choroid
Why is retinal detachment a sight threatening emergency
The outer retina relies on the blood vessels of the choroid for its blood supply
Risk factors for retinal detachment
Posterior vitreous detachment, diabetic retinopathy, trauma to the eye, retinal malignancy, older age, family history
Presentation of retinal detachment
Painless, peripheral vision loss, sudden and like a shaddow coming across vision, blurred or distorted vision, flashes and floaters
What is a rhegmatogenous retinal detachment
Break in the retina which allows fluid entry, lifting the retina
What is exudative non-rhegnatogenous retinal detachment
Fluid leaks from damaged blood vessels under the retina, which lifts the retina
What is tractional non-rhegmatogenous retinal detachment
Traction from the fibrovascular membranes, such as those in proliferative diabetic retinopathy and CRVO
Symptoms of retinal detachment with break in retina
flashes, floaters, distorted vision if macula involved, reduced visual acuity
Hisotry of patient with retinal detachment with break in retina
Myopia, diabetes
Investigations into retinal detachment
Ultrasonography
Management of retinal detachment with break
Emergency referral for surgical repair
History of patient with exudative retinal detachment
Systemic inflammation/infection
History of patient with tractional retinal detachment
Diabetes, CRVO
Symptoms of patient with exudative retinal detachment
visual field defect, distorted vision is macula involved, smooth dome in retina
Symptoms of patient with tractional retinal detachment
Progressive field loss, proliferation of retinal vessels
Management of exudative retinal detachment
Rarely requires surgery
Management of tractional retinal detachment
Retinal surgery depending on risk to macula and risk of progression to rhegmatogenous retinal detachment
Management of retinal tears
Laser therapy or cryotherapy
Management of retinal detachment
Vitrectomy, scleral buckling or pneumatic retinopexy
What does vitrectomy involve
Removing the relevant parts of the vitreous body and replacing it with oil or gas
What does scleral buckling involve
Using silicone buckle to put pressure on the outside of the eye (sclera) so that the outer eye indents to bring the choroid inwards and into contact with the detached area
What does pneumatic retinopexy involve
Injecting gas bubble into vitreous body and positioning the patient so the gas bubble creates pressure which flattens the retina against choroid and close the detachment
What is posterior vitreous detachment
Vitreous gel comes away from the retina
Presentation of posterior vitreous detachment
Painless, asymptomatic, spots of vision loss, floaters, flashing lights
Management of posterior vitreous detachment
No treatment, over time symptoms will improve as brain adjusts
What can posterior vitreous detachment precipitate
Retinal tear or detachment
Why is vitreous detachment common in elderly patients
The vitreous body becomes less firm and able to maintain its shape
