Rhegmatogenous RD Flashcards
The most common location
Upper temporal quadrant
Causes of Retinal break
Retinal tears
Retinal holes: round or oval
Retinal or vitreous degeneration
Vitreo-retinal adhesions : choriodo-retinits
Blunt trauma
Types of retinal tears:
Horse-shoe tears (U) the most common
Arrow head
Giant tear
Dialysis: circumferential along ora serrata
Risk factors of rhegmatogenous RD
Predisposing peripheral reinal degeneration:
High myopia(lattic degeneration)
Aphakia and cataract extraction
Trauma (blunt or perfor)
Family hx or hx of RD to fello eye
Acute posterior vitreous detachment
Symptoms
4F:
Photopsia: Flashes of light
Floaters: indicates vitreous hge (also called muscae volitantes)
Visual Field defect
Fail of central vision: dt involvement of macula
Metamorphopsia
Micropsia
How to exam
Visual acuity: determine the extent and whether the macula is involved or not
Slit-lamp: evidence of uveitis, A/C flare, vitreous for tobacco dust (evidence of tear)
IOP usually lower
Red reflex : Grey
Fundus exam: Retinal break+convex wavy grayish detached retina
Other signs
Marcus Gun pupil: relative afferent pupillary defect
Associated Iridocyclitis
Tobacco dust (Pig. Cells in vitreous)
The most important investigation in RD
Ocular US
History questions
Ask about 4F
Trauma?
Diabetic?
Symptoms of cancer?
Progressive?
Location of the field defect? Movable when moving the head?
What is tobacco dust or ghost cells in the vitreous, and why do they indicate for tears
It is an RPE cells that escaped through the tears to the vitreous
Therapeutic tx:
Scleral buckling (surgery of choice)
Pneumatic retinopexy (silphur hexafluoride)
Pars plana vitrectomy : giant tear, Tractional Diabetic RD or PVD
Prophylactic tx
Two or three rows of Argon laser surround the retinal tear
indications:
Flat retinal tears (without RD)
Peripheral retinal lesions predisposing to RD (Lattice degeneration)
