Retinal detachment

Question 1

DEFINITION

Answer 1

• The loose adhesion between the neuroretina and the retinal pigment epithelium (RPE) is broken
• 2 structures are anatomically separated from each other by the collection of fluid.

Question 2

CLASSIFICATION BY MECHANISM

Answer 2

1. SEROUS: Exudation occurs under the neuroretina–> inflammatory conditions
   tumours.
2. TRACTION: Vitreous bands cause mechanical traction on the neuroretina without causing retinal breaks.
   advanced diabetic retinopathy.
3. RHEGMATOGENOUS
   a) Retinal break (hole or tear).
4. Vitreous traction during posterior vitreous detachment
5. Direct blunt trauma to the eye. -Traction occurs during transient distortion of the globe.
6. Degenerative holes with vitreous traction.
   b) Vitreoretinal traction on the edge of the break.
   c) Fluid movement through the break.

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Question 3

SYMPTOMS

Answer 3

1. Posterior vitreous detachment: 
    Light flashes, floaters.
2. Vitreous haemorrhage: 
     Sudden shower of dot-like floaters.
3. Detachment:
    shadow or curtain over part of visual field
    sudden < vision when macula included

Question 4

SIGNS

Answer 4

1. < VF–> scotoma in area of the detachment.
2. < VA–> if macular detachment/ vitreous haemorrhage.
3. RAPD if large
4. No red reflex: retina irregular, white and opaque, obscuring the underlying choriocapillaris which is responsible for the red reflex.
5. Bulging white retinal folds containing blood vessels are

Question 5

Treatment

Answer 5

Flashes of light.

1. referred to an ophthalmologist within 24 hours for a thorough, dilated examination of the retina and vitreous.
2. Early detection and treatment of a retinal break will prevent subsequent retinal detachment.

A shadow or curtain over part of the visual field or a sudden painless loss of vision in a comfortable white eye–> If these symptoms occur, a retinal detachment must be excluded.

Retinal break without detachment:
All retinal breaks do not require treatment. In selected cases, an inflammatory reaction is initiated in the area of the break to cause adhesion between the neuroretina and the retinal pigment epithelium.
1. laser
2.cryotherapy.

Retinal detachment:
partial detachment –> threatens macula is an indication for urgent surgery. In principle, detachment surgery must address each of the three causative factors:
1. The neuroretinal break closed by reapplying the edges of the break to the RPE. Done by appropriately positioned injected gas bubble, or externally by indenting the outer layers of the eye with explants.
2. Vitreous traction relieved by vitrectomy or explants.
3. Subretinal fluid is drained.