Detachment

Question 1

What is retinal detachment

Answer 1

Retina separates from the choroid underneath

Question 2

What is the usual cause of retinal detachment

Answer 2

Usually due to retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and choroid

Question 3

Why is retinal detachment a sight threatening emergency

Answer 3

The outer retina relies on the blood vessels of the choroid for its blood supply

Question 4

Risk factors for retinal detachment

Answer 4

Posterior vitreous detachment, diabetic retinopathy, trauma to the eye, retinal malignancy, older age, family history

Question 5

Presentation of retinal detachment

Answer 5

Painless, peripheral vision loss, sudden and like a shaddow coming across vision, blurred or distorted vision, flashes and floaters

Question 6

What is a rhegmatogenous retinal detachment

Answer 6

Break in the retina which allows fluid entry, lifting the retina

Question 7

What is exudative non-rhegnatogenous retinal detachment

Answer 7

Fluid leaks from damaged blood vessels under the retina, which lifts the retina

Question 8

What is tractional non-rhegmatogenous retinal detachment

Answer 8

Traction from the fibrovascular membranes, such as those in proliferative diabetic retinopathy and CRVO

Question 9

Symptoms of retinal detachment with break in retina

Answer 9

flashes, floaters, distorted vision if macula involved, reduced visual acuity

Question 10

Hisotry of patient with retinal detachment with break in retina

Answer 10

Myopia, diabetes

Question 11

Investigations into retinal detachment

Answer 11

Ultrasonography

Question 12

Management of retinal detachment with break

Answer 12

Emergency referral for surgical repair

Question 13

History of patient with exudative retinal detachment

Answer 13

Systemic inflammation/infection

Question 14

History of patient with tractional retinal detachment

Answer 14

Diabetes, CRVO

Question 15

Symptoms of patient with exudative retinal detachment

Answer 15

visual field defect, distorted vision is macula involved, smooth dome in retina

Question 16

Symptoms of patient with tractional retinal detachment

Answer 16

Progressive field loss, proliferation of retinal vessels

Question 17

Management of exudative retinal detachment

Answer 17

Rarely requires surgery

Question 18

Management of tractional retinal detachment

Answer 18

Retinal surgery depending on risk to macula and risk of progression to rhegmatogenous retinal detachment

Question 19

Management of retinal tears

Answer 19

Laser therapy or cryotherapy

Question 20

Management of retinal detachment

Answer 20

Vitrectomy, scleral buckling or pneumatic retinopexy

Question 21

What does vitrectomy involve

Answer 21

Removing the relevant parts of the vitreous body and replacing it with oil or gas

Question 22

What does scleral buckling involve

Answer 22

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

Question 23

What does pneumatic retinopexy involve

Answer 23

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

Question 24

What is posterior vitreous detachment

Answer 24

Vitreous gel comes away from the retina

Question 25

Presentation of posterior vitreous detachment

Answer 25

Painless, asymptomatic, spots of vision loss, floaters, flashing lights

Question 26

Management of posterior vitreous detachment

Answer 26

No treatment, over time symptoms will improve as brain adjusts

Question 27

What can posterior vitreous detachment precipitate

Answer 27

Retinal tear or detachment

Question 28

Why is vitreous detachment common in elderly patients

Answer 28

The vitreous body becomes less firm and able to maintain its shape