Retina

Question 1

What is retinal detachment?

Answer 1

Holes/tears in the retina allow fluid to separate the sensory retinal from the retinal pigment epithelium.
If a retinal break is identified before a detachment occurs, cry/laser retinopexy may be preventive.

Question 2

What are types of retinal detachment?

Answer 2

Rhegmatogenous - a tear in the retina causes fluid to pass from the vitreous space into the sub retinal space between the sensory retina and the rental pigment epithelium. Typically caused by trauma.

Exudative retinal detachment - retina detaches with a tear - e.g. hypertension, vasculitis, macular denigration, tumours

Tractional retinal detachment: pulling on the retina, e.g. proliferative retinopathy
Myopic eyes are more prone to detachment, the higher the myopia, the greater the risk. Cataract surgery for myopia carries increased risk of detachment

Question 3

How does retinal detachment present?

Answer 3

4 Fs

Floaters
Flashes
Field loss
Fall in acuity

Painless and may be as a curtain falling over the vision (e.g. curtain falls down as the lower half of the retina detaches upwards.
Field defects indicate the position and extent of detachment - superior detachment - field loss is infection
central visual loss if macula is affected
Straight lines appear curved

Relative afferent pupillary defect

Question 4

What is seen on ophthalmoscopy?

Answer 4

Grey opalescent retinal ballooning forward.

Question 5

What is management for retinal detachment?

Answer 5

Rest is key
If detachment is superior, nurse flat
If detachment is infection, lie 30 degrees head up
Laser photocoagulation therapy

Refer urgently for surgery - vitrectomy and gas tamponade, scleral silicone implancts

Cryotherpay or laser coagulation is used to secure the retina.

Question 6

What is retinitis pigmentosa?

Answer 6

Inherited
Primarily affects peripheral retina resulting in tunnel vision

Night blindness initially
Tunnel vision due to loss of the peripheral retina

Question 7

What is seen on fundoscopy of retinitis pigmentosa?

Answer 7

Black bone spittle shaped pigmentation in the peripheral retina, mottling of the rental pigment epithelium

Question 8

What is posterior vitreous detachment?

Answer 8

Degenerative changes in the vitreous lead to its eventual separation from eh retina
Normal ageing
Patient describe photopsia (flashes of light) in the peripheral temporal field
Floaters increase but vision remains unchanged and there are no field defects
Refer for fundus check as tears of retina can happen s a consequence of PVD.

Question 9

Ddx of photopsia?

Answer 9

Retinal detachment
Migraine
PVD