Retinal Detachment

Question 1

what are the risks to retinal detachment?

Answer 1

Myopia, intraocular surgery, weakness in the retina and genetic conditions, trauma

Question 2

what are the different types of retinal detachment?

Answer 2

Rhegmatogenous
Exudative
Tractional

Question 3

what is a rhegmatogenous retinal detachment?

Answer 3

a tear in the retina causes fluid to pass from the vitreous space into the subretinal space between the sensory retina and RPE

Question 4

what are the causes of rhegmatogenous retinal detachment?

Answer 4

trauma

Question 5

what are the causes of exudative retinal detachment?

Answer 5

retina detaches without a tear via fluid accumulation in sub-retinal

Question 6

what are the causes of exudative retinal detachment?

Answer 6

hypertension. Vasculitis, macular degenerative conditions, tumour

Question 7

what is a tractional retinal detachments?

Answer 7

Tractional retinal detachments

Question 8

what are the causes of tractional retinal detachment?

Answer 8

proliferative retinopathy

Question 9

what are the clinical symptoms of retinal detachment?

Answer 9

• 4 Fs: floaters, flashes, field loss and fall in acuity
• Painless loss of vision
• Sudden onset of flashes/floaters
• May have RAPD
• Pull of macula – loss central vision
• Dense shadow peripherally progressing centrally
• Straight lines appear curved f

Question 10

what are the fundoscopic features of retinal detachment?

Answer 10

o Grey opalescent retina, ballooning forward – may look like a wrinkled fold
o Pigment of fundoscopy – tobacco dust
o Loss of red reflex

Question 11

what is the management of retinal detachment?

Answer 11

• If tear – laser
• Internal – vitrectomy/laser or cytopathy/bubble of gas as internal tamponade then positional
• External – scleral buckle
• Traction – excision of contracting

Question 12

what are the causes of posterior vitreous detachment?

Answer 12

ageing or myopes

Question 13

what is the pathophysiology of posterior vitreous detachment?

Answer 13

• Vitreous gel undergoes degenerative changes with liquefication and formation of fragments of condensed vitreous
• These cast shadows on the retina – floaters
• Vitreous gel collapses and separates from retinal attachments – can cause retinal tears

Question 14

what are the clinical features of posterior vitreous detachment?

Answer 14

• Flashes of light (photopsia) – in the peripheral field of vision
• Floaters, often on the temporal side of the central vision

Question 15

what are the causes of vitreous haemorrgage?

Answer 15

• Diabetic retinopathy, BRVO, CRVO
• Trauma
• Retinal tear and/or detachment
• Posterior vitreous

Question 16

what is the pathophysiology of vitreous haemorrhage?

Answer 16

• Leakage of blood into the areas in and around the vitreous humour
• Arise from retinal neovascularisation, retinal tears, retinal detachment or trauma

Question 17

what are the clinical features of vitreous haemorrhage?

Answer 17

• Sudden visual loss (if large total visual loss)
• Floaters/dark spots – blood in vitreous
• photopsia

Question 18

what are the fundoscopic features of vitreous haemorrhage?

Answer 18

o Loss of red reflex
o RBC in anterior vitreous
o Blood clots – dark swirling clouds

Question 19

what is the management of vitreous haemorrhage?

Answer 19

• spontaneous absorption

* in dense – vitrectomy

Question 20

what is RAPD?

Answer 20

when you shine a light in one eye constricts, then in other eye there will be paradoxical dilation (normally constricts too)