Retinal Detachment

Question 1

What is retinal detachment?

Answer 1

When the neurosensory layer of the retina (containing photoreceptors and nerves) separates from the retinal pigment epithelium (the base layer attached to the choroid).

Question 2

What is retinal detachment usually due to?

Answer 2

A retinal tear, allowing vitreous fluid to get under the neurosensory retina and fill the space between the layers.

Question 3

Why is retinal detachment sight threatening?

Answer 3

The neurosensory retina relies on the blood vessels of the choroid for its blood supply.

Therefore, retinal detachment can disrupt the blood supply and cause permanent damage to the photoreceptors, making it sight-threatening.

Question 4

Risk factors for retinal detachment?

Answer 4

• Age
• Posterior vitreous detachment
• Previous surgery for cataracts (accelerates posterior vitreous detachment)
• Myopia
• Eye trauma (consider boxing)
• FH
• Diabetic retinopathy

Question 5

Clinical features of retinal detachment?

Answer 5

• PainLESS
• Peripheral vision loss
• Blurred or distorted vision
• Flashers & floaters

Question 6

How may vision loss be described in retinal detachment?

Answer 6

Described as a curtain or shadow progressing to the centre of the visual field

Question 7

Referral criteria for retinal detachment?

Answer 7

Any patient with new onset flashes and floaters should be referred urgently (<24h) to an ophthalmologist for assessment.

Question 8

Mx of retinal tears?

Answer 8

Management of retinal tears aims to create adhesions between the retina and the choroid. The options are:

1) Laser therapy
2) Cryotherapy

Question 9

Mx of retinal detachment?

Answer 9

Management of retinal detachment aims to reattach the retina and reduce any traction or pressure that may cause it to detach again.

The options for reattaching the retina are:
1) vitrectomy
2) scleral buckle
3) pneumatic retinopexy