Lecture 16: retinal detachment

Question 1

What are the differential diagnosis for acute floaters and/or flashes?

Answer 1

Posterior vitreous detachment
Retinal tear/detachment
Migraine (classic or ocular)
Posterior uveitis
Vitreous haemorrhage secondary to proliferative diabetic retinopathy

Question 2

What are the symptoms of a retinal detachment?

Answer 2

Recent onset floaters
Recent onset flashes
Progressive field loss (‘curtain’ or ‘shadow’)
Reduction in visual acuity

Question 3

What are the risk factors of a retinal detachment?

Answer 3

Age (average age of presentation 60 years)
Myopia
Previous tear/detachment
Family history
Recent eye surgery
Trauma

Question 4

What causes a rhegmatogenous retinal detachment?

Answer 4

A retinal tear or break develops allowing fluid to enter the subretinal space, causing retinal detachment.

Question 5

What are the symptoms of a posterior vitreous detachment?

Answer 5

Recent onset floaters
Recent onset flashes
Often asymptomatic

Question 6

How common is PVD?
What are the risk factors?

Answer 6

Age-related event
-24% of adults 50-59 years
-87% 80-89 years

Age
Myopia
Trauma
Intraocular inflammation

Question 7

What causes a PVD?

Answer 7

A change in the relative proportions of gel and liquid compartments in the vitreous causing a separation between the posterior hyaloid and the retina

Question 8

What is the likelihood of a retinal tear following PVD?

Answer 8

14%

Question 9

What types of flashes is someone with vitreo-retinal traction likely to have?

What is the most consistent symptom of retinal detachment?

Answer 9

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

Question 10

What clinical tests should you do?

Answer 10

check vision
Confrontation visual fields (small target)
Check for RAPD
Measurement of IOP
Pigment in anterior vitreous (Shafers sign)
Dilated fundus examination

Question 11

What is shafers sign?
What is it suggestive of?

Answer 11

Retinal pigment may pass through retinal breaks. Pigment in the vitreous is known as Shafers sign

highly suggestive of a retinal break

Question 12

What type of retinal tear can you get due to vitreous traction?

Answer 12

Horseshoe tears
full thickness breaks in the neurosensory retina

Question 13

What is a retinal hole caused by?

What is it?

Answer 13

focal vitreoretinal traction

Avulsion of the retinal tissue results in the free-floating operculum

Question 14

What causes atrophic holes?

Answer 14

Atrophic holes develop independently of vitreous traction

Patients are often asymptomatic

Low risk since there is no traction from the vitreous

Question 15

What pathology can you get tractional retinal detachments from?

How does it occur?

Answer 15

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.

Question 16

What can cause dialysis of retina?

Answer 16

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

Question 17

What can a chronic RD look like?

Answer 17

retina atrophies and there may be some restoration of transparency

Question 18

What is the nature of exudative or serous retinal detachment?

What are the signs?

What is the treatment?

Answer 18

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

Question 19

What is the chance of a retinal tear progressing to RD without treatment?

Answer 19

33-46%

Question 20

What treatment can be used to prevent retinal detachments from retinal breaks?

Answer 20

Retinopexy (by laser or cryotherapy)
-application of a single very large freeze to the retinal break

Question 21

What are the treatments for retinal detachment?

Answer 21

Scleral buckling
Vitrectomy
Pneumatic retinopexy- injection of intraocular gas

Question 22

What treatment is there for tractional retinal detachment?

Answer 22

delamination of the membranes

Question 23

When should you do an emergency referral for a px with flashes or lfaoters?

Answer 23

retinal detachment
pigment in the anterior vitreous (tobacco dust)
vitreous, retinal or pre-retinal hemorrhage
lattice degeneration or retinal break with symptoms