Lecture 16: retinal detachment Flashcards
What are the differential diagnosis for acute floaters and/or flashes?
Posterior vitreous detachment
Retinal tear/detachment
Migraine (classic or ocular)
Posterior uveitis
Vitreous haemorrhage secondary to proliferative diabetic retinopathy
What are the symptoms of a retinal detachment?
Recent onset floaters
Recent onset flashes
Progressive field loss (‘curtain’ or ‘shadow’)
Reduction in visual acuity
What are the risk factors of a retinal detachment?
Age (average age of presentation 60 years)
Myopia
Previous tear/detachment
Family history
Recent eye surgery
Trauma
What causes a rhegmatogenous retinal detachment?
A retinal tear or break develops allowing fluid to enter the subretinal space, causing retinal detachment.
What are the symptoms of a posterior vitreous detachment?
Recent onset floaters
Recent onset flashes
Often asymptomatic
How common is PVD?
What are the risk factors?
Age-related event
-24% of adults 50-59 years
-87% 80-89 years
Age
Myopia
Trauma
Intraocular inflammation
What causes a PVD?
A change in the relative proportions of gel and liquid compartments in the vitreous causing a separation between the posterior hyaloid and the retina
What is the likelihood of a retinal tear following PVD?
14%
What types of flashes is someone with vitreo-retinal traction likely to have?
What is the most consistent symptom of retinal detachment?
Intermittent white flashes of light in the temporal visual field (often described as camera or lightning flashes)
A progressively enlarging shadow, starting peripherally and advancing centrally
What clinical tests should you do?
check vision
Confrontation visual fields (small target)
Check for RAPD
Measurement of IOP
Pigment in anterior vitreous (Shafers sign)
Dilated fundus examination
What is shafers sign?
What is it suggestive of?
Retinal pigment may pass through retinal breaks. Pigment in the vitreous is known as Shafers sign
highly suggestive of a retinal break
What type of retinal tear can you get due to vitreous traction?
Horseshoe tears
full thickness breaks in the neurosensory retina
What is a retinal hole caused by?
What is it?
focal vitreoretinal traction
Avulsion of the retinal tissue results in the free-floating operculum
What causes atrophic holes?
Atrophic holes develop independently of vitreous traction
Patients are often asymptomatic
Low risk since there is no traction from the vitreous
What pathology can you get tractional retinal detachments from?
How does it occur?
proliferative retinopathy due to diabetic disease, sickle cell and other disease processes leading to neovascularization of the retina
Fibrovascular membranes on the surface of the retina or vitreous. pull on the neurosensory retina causing a tractional detachment.
What can cause dialysis of retina?
secondary to trauma
Recreational activities – Boxing, Rugby
Can occur months after the event
Vitreous is intact and attached to the retina so vitectomy is very risky
What can a chronic RD look like?
retina atrophies and there may be some restoration of transparency
What is the nature of exudative or serous retinal detachment?
What are the signs?
What is the treatment?
These are inflammatory in nature
Examples: posterior sclerits and VKH
There maybe an underlying systemic condition – sarcoidosis
Usually total RD
No tobacco dusting and associated with poor vision
Treatment is immunosuppression therapy – steroids
What is the chance of a retinal tear progressing to RD without treatment?
33-46%
What treatment can be used to prevent retinal detachments from retinal breaks?
Retinopexy (by laser or cryotherapy)
-application of a single very large freeze to the retinal break
What are the treatments for retinal detachment?
Scleral buckling
Vitrectomy
Pneumatic retinopexy- injection of intraocular gas
What treatment is there for tractional retinal detachment?
delamination of the membranes
When should you do an emergency referral for a px with flashes or lfaoters?
retinal detachment
pigment in the anterior vitreous (tobacco dust)
vitreous, retinal or pre-retinal hemorrhage
lattice degeneration or retinal break with symptoms
