Retinal detachment is the separation of the retina from the retinal pigment epithelium. It is one of the most commonly encountered ophthalmologic emergencies (along with occlusion of the retinal artery, endophthalmitis, and trauma). Retinal detachment has a good prognosis provided it is diagnosed early and the macula is spared. Late diagnosis can lead to total loss of vision in the affected eye. Patients typically present with acute peripheral loss of vision in the affected eye (described as cloudy or curtain-like). Visual acuity can be preserved provided the macula is not detached.
1 in 300 individuals develop retinal detachment in their lives. The incidence increases with age. It is commonly seen in patients aged 40-70 years. 25% of patients with retinal detachment will develop retinal detachment in the contralateral eye at some point in their lives.
Mechanisms of Retinal Detachment (RD)
| Mechanism | Pathophysiology | Patient History |
|---|---|---|
| Exudative (Serous) RD | Accumulation of serous/hemorrhagic fluid in the subretinal space due to hydrostatic force or acute inflammation | Severe hypertension, Central Retinal Vein Occlusion, Neoplastic Effusion |
| Tractional RD | Centripetal mechanical force on the retina due to pre-existing scars tears the retina from the RPE | Past inflammatory process, diabetic retinopathy, trauma/injury, past surgery, Retinopathy of Prematurity |
| Rhegmatogenous RD | Normal senescent changes in the vitreous (becomes more liquefied) cause posterior vitreous detachment which can tear the retina. Vitreous fluid then fills the subretinal space and detatches the retina. | Most common form. |
- Risk factors
- Age
- Myopia (probably because an elongated eye may stretch the retina and cause it to weaken)
- Previous Cataract Surgery (due to placement of an IOL)
- Aphakia
- Ocular trauma
- Smoking
- Diabetic Retinopathy
- HIV Retinopathy
- Patient History Ask how long the symptoms have been present and how quickly it progressed
- Diabetes Mellitus
- Trauma
- Eye surgery
- Ophthalmologic conditions (e.g. myopia)
- Family History of Retinal Detachment
- Signs and symptoms
- Photopsia (sensation of flashing lights caused by stimulation of the retina as it detaches)
- Decreased peripheral vision
- Floaters
- Photophobia
- Change in visual acuity
- Physical exam
- Visual acuity
- Visual field exam
- External eye exam
- Pupillary response (Relevant Afferent Pupillary Defect/Marcus-Gunn Pupil)
- Investigations
- Indirect Ophthalmoscopy
- Detatched portion appears grey and cloudy (the superior temporal quadrant is most commonly affected)
- The tear can be visualized
- Vitreous hemorrhage
- Ocular ultrasound: if the patient cannot tolerate light from the ophthalmoscope
- Orbital CT
- Orbital MRI
- Indirect Ophthalmoscopy
- Treatment
- Urgent Surgery to reattach the retina to the RPE
- Approximately 80% of retinal re-attachment surgeries are successful on first attempt
- 10% of patients require additional procedures
- The remaining will be unsuccessful
- Urgent Surgery to reattach the retina to the RPE
