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Retinal detachment

Separation of the neurosensory retina from the underlying retinal pigment 
epithelium with accumulation of subretinal fluid and loss of retinal function

Acute retinal detachment is usually preceded by a symptomatic separation of the posterior vitreous from the retina , a posterior vitreous detachment ( PVD ) giving rise to tractional retinal breaks ( retinal tears )

Symptoms of PVD include light flashes and floaters and such patients are at high risk pf retinal detachment

Risk factors- Increasing age Myopia Family history Previous history Eye trauma ( not head ) Previous cataract surgery RD on other eye Proliferative diabetic retinopathy Inflammatory conditions Malignancy Congenital eye disease

Presentation- Photopsia ( recent onset ) 
○ common initially
○ perception of light not attributable to an incident light
○ usually described as recurrent brief flashes in the temporal peripheral field , but can occur anywhere
 New onset floaters
○ caused by vitreous opacities casting shadows on the retina
○ perception of mobile dots , lines , or haze
 Sudden onset painless and usually progressive visual field loss
○ visual field defect is opposite the site of detachment because of optical inversion of images
○ described as ” dark curtain” or shadow appearing 1st in the periphery and moving to centre over hrs , days , or even weeks and detachment extends
 Reduction in visual acuity
○ blurred or distorted vision
○ if macula detaches → loss of central acuity

Visual acuity
○ ↓ VA usually indicates macular detachment
○ vitreous haemorrhage may also reduce vision Visual field test
○ may show asymptomatic peripheral filed defect Affarent pupillary defect
○ extensive retinal detachment will produce a relative affarent pupillary defect○ shining bright torch alternatively on one eye for 2 seconds then rapidly swinging it on to the other eye →

pupils will dilate when torch is swung to affected eye
constrict when it shines on the unaffected eye

brightness signal being sent to the brain from the eye with the detachment
 Fundoscopy – retinal detachment cannot be excluded by direct ophthalmoscopy. Findings can include-
○ loss of red reflex
○ vitreous opacities
○ detached retinal folds →in larger detachments
○ no abnormality may be seen if detachment is small
 Slit lamp examination Indirect ophthalmoscopy B Scan ocular ultrasonography

New onset flashes and / or floaters and 
Visual field loss
Distorted or blurred vision
Fundoscopic signs of retinal detachment
 or vitreous haemorrhage- Refer immediately to 
Ophthalmologist

New onset flashes and or/ floaters and 

No visual field loss
No change in VA No fundoscopic signs of RT or VA-Slit lamp and Indirect 
ophthalmoscopy within 24 hrs

Most retinal detachments not 
involving the macula are repaired 
the same day or the following day

If macula detached – should be reattached within
 5 days urgency influenced by
 other factors as duration
 of symptoms , height of macular
 detachment and VA

Reference

  1. Management of retinal detachment: a guide for non-ophthalmologists BMJ 2008;336:1235
  2. Evaluation and Management of Suspected Retinal Detachment Am Fam Physician.2004 Apr 1;69(7):1691-1699
  3. Retinal Detachment Hemang K Pandya Messcape accessed via http://emedicine.medscape.com/article/798501-overview
  4. Management of acute retinal detachment. Royal College of Ophthalmologists accessed via
https://www.rcophth.ac.uk/wp-content
/uploads/2014/12/2010_PROF_064_OSG-Retinal-Detachment-June-2010.pdf
  5. First Consult – Retinal detachment
  6. GP Factsheet Advice for floaters and Flashing Lights for primary care
  7. Blair K, Czyz CN. Retinal Detachment. [Updated 2020 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK55150 
  8. Danny Mitry, David G. Charteris, David Yorston, M. A. Rehman Siddiqui, Harry Campbell, Anna-Louise Murphy, Brian W. Fleck, Alan F. Wright, Jaswinder Singh, the Scottish RD Study Group; The Epidemiology and Socioeconomic Associations of Retinal Detachment in Scotland: A Two-Year Prospective Population-Based Study. Invest. Ophthalmol. Vis. Sci. 2010;51(10):4963-4968. doi: https://doi.org/10.1167/iovs.10-5400.

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