Retinal Detachment

Question 1

What is Retinal detachment?

Answer 1

Retina separates from Choroid underneath

Question 2

What happens in Retinal detachment? (2 steps)

Answer 2

1. Retinal tear –> allows Vitreous fluid to get underneath retina
2. VF fills space between Retina + Choroid

Question 3

Why can a Retinal detachment be a Medical Emergency?

Answer 3

Outer retina relies on blood vessels of Choroid

Question 4

What are the RF for Retinal detachment? (8 things)

Answer 4

1. Age 40+
2. Male
3. FHx
4. Trauma
5. Previous eye surgery
6. Retinal detachment in other eye
7. DM Retinopathy
8. Retinal malignancy

Question 5

What are the CF of Retinal detachment? (3 things)

Answer 5

1. Painless Progressive Peripheral loss of vision (like shadow moving across field of vision)
2. Blurred / distorted vision
3. Flashers and Floaters

Question 6

What are Flashers and Floaters?

Answer 6

Question 7

What investigation should you do for sus Retinal detachment?

Answer 7

Fundoscopy

Question 8

What will you see on Fundoscopy in Retinal detachment?

Answer 8

Question 9

What other investigations can you do for Retinal detachment?

Answer 9

US

Question 10

What is the point of doing an US in Retinal detachment?

Answer 10

If there is Vitreous haemorrhage caused by Tear involving retinal vessel

Question 11

What are some DDx that present similarly to Retinal detachment? (2 things)

Answer 11

1. Retinoschisis (split within neurosensory layer)
2. Choroidal mass (solid mass assoc w fluid)

Question 12

How do you differentiate between Retinoschisis and Retinal detachment?

Answer 12

Retinoschisis: No corrugated appearance on fundoscopy

Question 13

How do you differentiate between Choroidal mass and Retinal detachment?

Answer 13

Choroidal mass: No retinal pear / pigment in Vitreous

Question 14

What are the Mx aims for Retinal TEARS?

Answer 14

Create adhesions between Retina + Choroid to prevent detachment

Question 15

How can a Retinal Tear be Mx to prevent detachment? (2 things)

Answer 15

1. Laser therapy
2. Cryotherapy

Question 16

What are the Mx aims for Retinal detachment? (2 things)

Answer 16

1. Reattach retina
2. Reduce traction / pressure that may cause it to detach again

Question 17

What are the Mx options for Reattaching a detached retina? (3 things)

Answer 17

1. Vitrectomy
2. Scleral buckling
3. Pneumatic retinopexy

Question 18

What does Vitrectomy involve?

Answer 18

Removing relevant parts of Vitreous body + replacing it w oil / gas

Question 19

What does Scleral buckling involve? (2 steps)

Answer 19

1. Using silicone “buckle” to put pressure on outside of eye (sclera)
2. Outer eye indents –> brings choroid inwards –> in contact w detached retina

Question 20

What does Pneumatic retinopexy involve? (3 steps)

Answer 20

1. Injecting gas bubble into vitreous body
2. Position pt so gas bubbles create pressure
3. Pressure flattens retina against choroid + closes detachment

Question 21

What is the main complication of Retinal detachment?

Answer 21

Partial / complete unilateral vision loss

Question 22

What type of Retinal detachment has the worst prognosis?

Answer 22

Retinal detachment involving Macula