retinal detachment Flashcards
differential diagnoses for acute floaters and/or flashes?
- PVD
- retinal tear/detachment
- migraine (classic or ocular)
- posterior uveitis
- vitreous haemorrhage secondary to R3 (DR)
symptoms of RD
- recent onset floaters
- recent flashes
- progressive field loss (curtain/shadow)
- reduction in VA
how common is RD
10-15 per 100,000 people
risk factors of RD
- age (~60 years)
- myopia
- previous tear/detachment
- family history
- recent eye surgery
- trauma
what is rhegmatogenous RD?
a retinal tear or break develops allowing fluid to enter the subretinal space causing RD
what is the most comon type of RD?
rhegmatogenous
symptoms of PVD?
- recent onset floaters
- recent onset flashes
- often asymptomatic
how common is PVD?
age-related
24% adults 50-59 and 87% of 80-89 year olds
risk factors of PVD
- 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
likelihood of a retinal tear following a PVD?
14%
what happens to the photoreceptors when the RPE detaches?
they die VVV quickly
therefore emergency referral
what is a weiss ring?
a small amount of tissue from the optic disc that has been pulled away as the vitreous has detached
common sign of PVD?
weiss ring floater
H&S questions to ask ?
- risk factors
- photopsia characteristics, duration and laterality
- size, shape and distribution of floaters
- onset, nature and duration of change in vision
what qs do you ask the px in H&S to check for risk factors?
- myopia
- recent ocular surgery
- blunt trauma
- diabetes
- systemic inflammatory condition
if px is complaining of intermitted WHITE flashes of light in termporal visual field, what is this likely to be?
vitreo-retinal traction
if px is complaining of coloured lights and zig-zag lines in the visual field of 1 or 2 eyes simultaneously and lasts for mintes or hours at a time, what is this likely to be?
neurovascular origin (migraines)
what is a tell-tale sign of RD?
curtain/veil
progressively enlarging shadow starting peripherally and advancing centrally
are symptoms a good predictor of a retinal tear?
not really (unless a shadow/curtain/veil)
what clinical tests would you do to detect RD?
- vision
- confrontation VF (NOT ON A MACHIINE - USELESS IN RD)
- RAPD
- IOP
- shafers
- dilated fundus exam
what is shafers sign?
retinal pigment in the anterior vitreous
how does shafers sign occur?
when there is a break in the retina, RPE cells migrate forwards to anterior
what is shafers sign also called?
tobacco dust
if a px is shafers +ve, what is the likelihood they have a retinal tear?
88%
what is a horseshoe tear?
full thickness break in the neurosensory retina that occurs secondary to vitreous traction
does a px have symptoms with an atrophic hole?
often asymptomatic
does having an atrophic hole make you more likely to have RD?
no - therefore can observe
which disease do you see tractional RD?
proliferative retinopathy
(DR, sickle cell anemia, and other diseases leading to neovas in retina)
what causes tractional RD?
fibrovascular membranes on the surface of the retina or vitreous pull on the neurosensory retina
what are the 2 treatment options for retinal tears?
retinopexy
LASER OR CRYOTHERAPY
when managed optimally, what % of RD can be repaired with single intervention?
80-90%
treatment of complicated RD?
- scleral buckling
- vitrectomy
- pneumatic retinopexy
what is scleral buckling?
a piece of ‘sponge’ or ‘rubber band’ is placed on the sclera to create an indent and move it closer to the retina
may need to drain away excess SRF before doing the procedure
GOC says, if you suspect a retinal break or tear, what is the minimum you should do?
- detailed H&S
- examine anterior vitreous for shafers
- perform a dilated fundus examination using an indirect viewing technique
- give appropriate advice to the px which you back up with written info
GOC says you can do an emergency referral, if there is….
- retinal detachment
- positive shaffers sign
- vitreous, retinal or pre-retinal haemorrhage
- lattice degeneration or retinal break with symptoms
