Retinal Detachment

Question 1

What is retinal detachment (RD)?

Answer 1

Separation of neurosensory retina from retinal pigment epithelium and collection of subretinal fluid

Active space indicates the presence of subretinal fluid.

Question 2

Name the types of retinal detachment.

Answer 2

• Primary/Rhegmatogenous RD
• Secondary RD
• Tractional RD
• Exudative RD

Each type has different causes and mechanisms.

Question 3

What is the primary cause of Primary Rhegmatogenous Retinal Detachment (RRD)?

Answer 3

Retinal breaks develop due to dynamic vitreoretinal traction d/t liquefaction of vitreous

This occurs when fluid enters the subretinal space.

Question 4

What are the investigations used for retinal detachment?

Answer 4

• Indirect ophthalmoscopy
• Optical coherence tomography (OCT)
• B-scan ultrasonography

These methods help visualize the retina and assess detachment.

Question 5

What is the pathogenesis of retinal detachment?

Answer 5

• Syneresis (liquefaction of vitreous)
• Posterior vitreous detachment (PVD)
• Dynamic vitreoretinal traction

These factors contribute to the development of retinal breaks.

Question 6

List the causes of retinal detachment.

Answer 6

• Pathological myopia (most common)
• Blunt trauma
• Cataract surgery (Aphakia)
• Lattice degeneration of retina

These conditions can make the retina fragile and prone to detachment.

Question 7

What are the symptoms of retinal detachment?

Answer 7

• Photopsia (flashes of light)
• Floaters (small black flying dots)
• Curtain falling in front of the eye
• Sudden painless loss of vision

Symptoms arise due to the pulling force of the vitreous on the retina.

Question 8

What is the appearance of a detached retina?

Answer 8

• Gray/opaque
• Convex shaped

The extent of retinal detachment can be assessed until the ora serrata.

Question 9

What is Shafer’s sign associated with retinal detachment?

Answer 9

• Tobacco-dust appearance
• Deposition of brown pigmented cells at the anterior surface of vitreous

This sign indicates the presence of subretinal fluid.

Question 10

What are the clinical features of retinal detachment?

Answer 10

• Photopsia
• Floaters
• Loss of vision: Sudden, painless
• Shape of RD: Convex
• Hallmark features: Shifting fluid with shifting head position

The extension of RD can be assessed until the ora serrata.

Question 11

What is the most common cause of tractional retinal detachment?

Answer 11

Diabetic retinopathy

Other causes include retinopathy of prematurity, penetrating trauma, and sickle cell retinopathy.

Question 12

What is the primary characteristic of exudative retinal detachment?

Answer 12

Exudation into subretinal space

Common causes include choroidal melanoma, toxemia of pregnancy, and Coats’ disease.

Question 13

What is the shape of retinal detachment in exudative cases?

Answer 13

Concave

This type of detachment often leads to gradual and painless loss of vision.

Question 14

What is the management approach for retinal detachment?

Answer 14

The most common location for retinal breaks is the superotemporal quadrant.

Question 15

What is the most common location for a u-shaped retinal tear?

Answer 15

Superotemporal quadrant

This location is significant for identifying breaks in the retina.

Question 16

What are the Lincoff rules used for?

Answer 16

To locate breaks in the retina

These rules help in identifying the specific areas of retinal detachment.

Question 17

What is the treatment for retinal detachment involving gas?

Answer 17

Pneumatic retinopexy

This method uses gas (e.g., propane) to push the retinal pigment epithelium anteriorly.

Question 18

What is a potential complication of silicone oil used in retinal detachment treatment?

Answer 18

Hyperoleon

This occurs when oil leaks into the anterior chamber and collects superiorly, leading to an inverse hypopyon.

Question 19

What is the treatment for chronic retinal detachment?

Answer 19

• Vitrectomy
• Subretinal fluid drainage

These procedures aim to restore the retina’s mobility.

Question 20

Which type of loss of vision is seen in fractional RD ?

Answer 20

Gradual and painless

Question 21

Etymology of exudative RD ?

Answer 21

Choroidal melanoma
Toxaemia of pregnancy
VKH syndrome
Coat’s ds

Question 22

In which type of RD shifting fluid is seen with shifting head position ?

Answer 22

Exudative RD

Question 23

Shapes of each type of RD

Answer 23

Primary RD —> convex
Traditional RD —> concave
Exudative RD —> convex