retinal detachment

see also:

• ophthalmology
• the patient with acute blurred vision or visual loss / blindness

• retinal detachment occurs by 3 main mechanisms:
  • rhegmatogenous retinal detachment
    • most common form
    • break in the neuronal layer with resultant leakage of vitreous between the retinal layers causing separation of the layers
  • traction retinal detachment
    • vitreous gel becomes adherent to retina and pulls the layer off
  • exudative (serous) retinal detachment
    • retinal vessels exude serous fluid between the retinal layers
    • aetiology:
      • RVO
      • papilloedema
      • retinopathy such as hypertension, diabetes mellitus, vasculitis

• may have photopsia (flashes of light), visual field defect, floaters
• vision loss may be described as cloudy, irregular, or curtainlike
• if involves the macula, vision loss may be severe
• signs of pigment or tobacco dust in the vitreous (ie, Shafer sign), which is suggestive for a retinal tear in 70% of cases with no previous eye disease or surgery
• indirect fundoscopy is needed to reliably diagnose this condition

• PH ocular trauma even months prior
• uveitis
• vitreous hemorrhage
• amblyopia
• glaucoma
• diabetic retinopathy
• FH (although most are sporadic cases with no FH)
• some medications may increase risk
  • sildenafil

• nil orally
• if traumatic, protect the globe with metallic eye shield
• avoid any pressure on the globe and to limit activity to a minimum until further evaluation
• full eye exam including indirect fundoscopy
• if macula likely to be involved urgent ophthalmologist review within 24hrs
• avoid strenuous activity until seen by ophthalmologist