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Retinal Detachment




General


  • Retinal detachment is a separation of the neurosensory retina from the underlying retinal pigment epithelium and choroid
  • Ophthalmogic emergency: without correction, permanent vision loss may occur in affected neurons

Types


  • Rhegmatogenous (most common type): retinal tear leads to separation of retina from underlying epithelium
  • Risk factors include: myopia, prior cataracts surgery, and eye trauma
  • Traction: fibrosis/fibrovascular proliferation leads to scar tissue that pulls off retina
  • Causes include: proliferative diabetic retinopathy, sickle cell retinopathy, and retinopathy of prematurity
  • Serous: accumulation of subretinal fluid in subretinal space
  • Causes include: severe hypertension (hydrostatic forces), sarcoid uveitis, and choroid malignancy

Features


  • Painless unilateral vision loss
  • Vision loss develops peripherally and progresses centrally
  • Classically described as a curtain being drawn down over the eye
  • Unilateral increase in floaters
  • Photopsia (flashing lights)

Diagnosis and Management


  • Ophthalmologic examination to assess the peripheral retina
  • Fundoscopic exam may reveal detached tissue flapping in the vitreous humor
  • Shafer’s sign (tobacco dust): pigmented cells in the anterior vitreous humor
  • Consider ocular ultrasound if ophthalmoscopy is non-diagnostic
  • Emergent ophthalmology consult for laser surgery, cryosurgery, pneumatic retinopexy, scleral buckling, or virectomy.