Retinal Detachment Disease

DESCRIPTION
Separation of the sensory retina from the underlying retinal pigment epithelium.
  • Rhegmatogenous retinal detachment (RRD): The most common type. Occurs when the fluid vitreous gains access to the subretinal space through a break in the retina (Greek rhegma, rent).
  • Exudative or serous detachment: Occurs in the absence of a retinal break, usually in association with inflammation or a tumor.
  • Traction detachment: Vitreoretinal adhesions mechanically pull the retina from the retinal pigment epithelium. The most common cause is proliferative diabetic retinopathy.
  • System(s) affected: Nervous
  • Genetics: Most cases are sporadic
  • Incidence/Prevalence in USA:
    • 1/10,000 per year in patients who have not had cataract surgery
    • 1-3% of patients after cataract surgery will develop a retinal detachment
  • Predominant age: The incidence increases with age.
  • Predominant sex: Male > Female (3:2)
SIGNS AND SYMPTOMS
  • Flashes (photopsia)
  • Floaters
  • Visual field loss
  • Pigmented cells within the vitreous "tobacco dust"
  • Central vision will be preserved if the macula is not detached
  • Poor visual acuity (20/200 or worse) with loss of central vision when macula is detached
  • Elevation of retina associated with one or more retinal tears in RRD or elevation of the retina without tears in exudative detachment
  • In 3-10% of patients with presumed RRD, no definite retinal break is found
  • Tenting of the retina without retinal tears in traction detachment
CAUSES
  • Traction from a posterior vitreous detachment (PVD) causes most retinal tears. With aging, vitreous gel liquefies leading to the separation of the vitreous from the retina. The vitreous gel remains attached at the vitreous base, in the retinal periphery, resulting in vitreous traction producing tears in the retinal periphery.
  • PVD associated with vitreous hemorrhage has a high incidence of retinal tears
  • Exudative detachment:
    • Tumors
    • Inflammatory diseases (Harada's, posterior scleritis)
    • Miscellaneous (central serous retinopathy, uveal effusion, malignant hypertension)
  • Traction detachment:
    • Proliferative diabetic retinopathy
    • Cicatricial retinopathy of prematurity
    • Proliferative sickle cell retinopathy
    • Penetrating trauma
RISK FACTORS
  • Myopia (greater than 5 diopters)
  • Aphakia or pseudophakia
  • PVD and associated conditions (aphakia, inflammatory disease, and trauma)
  • Trauma
  • Retinal detachment in fellow eye
  • Lattice degeneration: a vitreoretinal abnormality found in 6-10% of the general population
  • Glaucoma: 4-7% of patients with retinal detachment have chronic open-angle glaucoma
  • Vitreoretinal tufts: peripheral retinal tufts caused by focal areas of vitreous traction
  • Meridional folds: redundant retina usually found in the supranasal quadrant
LABORATORY

N/A
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS
Elevation of the neurosensory retina from the underlying retinal pigment epithelium.
SPECIAL TESTS
  • Visual field testing: Differentiate between a RRD and retinoschisis. An absolute scotoma is seen in retinoschisis whereas a RRD causes a relative scotoma.
  • Ultrasonography: Can demonstrate a detached retina and may be helpful when the retina cannot be visualized directly (e.g., cataracts).
IMAGING
Fluorescein dye leakage can be seen in exudative retinal detachment caused by central serous retinopathy and other inflammatory conditions
DIAGNOSTIC PROCEDURES
  • Slit lamp examination
  • Dilated fundus examination with binocular indirect ophthalmoscopy
APPROPRIATE HEALTH CARE

Referral to an ophthalmologist for examination and treatment, if indicated

GENERAL MEASURES
  • Not all retinal tears or breaks need to be treated:
    • Flap tears or horseshoe tears in symptomatic patients (with flashes or floaters) frequently are treated
    • Operculated holes in symptomatic patients are sometimes treated
    • Atrophic holes in symptomatic patients are rarely treated
  • Lattice degeneration with or without holes within the lattice in an asymptomatic patient with prior retinal detachment in the fellow eye may be prophylactically treated
  • Flap retinal tears in asymptomatic patients are frequently treated prophylactically
  • Exudative detachments are usually managed by treatment of the underlying disorder
  • Traction detachments are usually managed by observation; if the fovea is involved, a vitrectomy is needed
SURGICAL MEASURES
  • Timing of repairs:
    • Macula attached: within 24 hours. If the detachment is peripheral and does not have features suggestive for rapid progression (such as large and/or superior tears), repair can be performed within a few days.
    • Macula recently detached: within one week of development of a macula-off retinal detachment
    • Old macular detachment: elective repair within 2 weeks
  • If a retinal break has led to the development of a retinal detachment, surgery will be needed. Surgical options (and combinations) include:
    • Pneumatic retinopexy: head positioning required postoperatively
    • Scleral buckle
    • Vitrectomy
    • Perfluorocarbon liquids for giant tears (circumferential tears 90° or larger)
    • Silicone oil for complex repairs
  • Anesthesia: usually local anesthesia
  • RRD may have more than one break. If any retinal break is not closed at the time of surgery, the surgery will fail
  • Additional surgery may be required if the retina redetaches secondary to a new retinal break or due to proliferative vitreoretinopathy (PVR)
ACTIVITY

Bedrest prior to surgery. Postoperatively, if an intraocular gas has been used, the patient may need specific head positioning and should not travel to high altitudes.

DIET

NPO if surgery is imminent

PATIENT EDUCATION

American Academy of Ophthalmology, 655 E. Beach Street, San Francisco, California 94109-1336

PREVENTION/AVOIDANCE

Patients at risk for a retinal detachment should have regular ophthalmologic examination

POSSIBLE COMPLICATIONS
  • PVR (Proliferative Vitreoretinopathy) is the most common cause of failed retinal detachment repair. 10-15% of patients, whose retinas reattach initially after retinal surgery, will subsequently re-detach, usually within 6 weeks due to cellular proliferation and contraction on the retinal surface.
  • Partial or total loss of vision due to macular detachment and/or PVR
  • Moderate to severe forms of PVR are usually treated with pars plana vitrectomy and fluid-gas exchange. If a segmental scleral buckle was placed at the initial procedure, it may need revision.
  • Scleral buckles may erode the overlying conjunctiva and lead to infection
EXPECTED COURSE AND PROGNOSIS
  • RRD (Rhegmatogenous Retinal Detachment):
    • 90% of retinal detachments can be reattached successfully after one or more surgical procedures. Postoperative visual acuity depends primarily on the status of the macula preoperatively. Also important is the length of time between the detachment and the repair (75% of macular detachments of less than one week will obtain a final visual acuity of 20/70 or better).
    • 87% of eyes with a retinal detachment not involving the macula attain a visual acuity of 20/50 or better postoperatively. 37% of eyes with a detached macula preoperatively attain 20/50 or better vision postoperatively.
    • In 10-15% of successfully repaired retinal detachments not involving the macula preoperatively, visual acuity does not return to the preoperative level. This decrease is secondary to complications such as macular edema or macular pucker.
  • Tractional retinal detachment:
    • When not involving the fovea, the patient can usually be observed since it is uncommon for these to extend into the fovea.
  • Exudative retinal detachment:
    • Management is usually nonsurgical
    • The presence of shifting fluid is highly suggestive of an exudative retinal detachment. Fixed retinal folds, which are indicative of PVR, are rarely seen in exudative retinal detachment. If the underlying condition is treated, the prognosis is generally good.
ASSOCIATED CONDITIONS
  • Lattice degeneration
  • High myopia
  • Cataract surgery
  • Glaucoma
  • History of retinal detachment in the fellow eye
  • Trauma
AGE-RELATED FACTORS

Pediatric: Usually associated with underlying vitreoretinal disorders and/or retinopathy of prematurity
Geriatric:

  • Posterior vitreous detachment
  • Cataract surgery

Others: N/A

PREGNANCY

Pre-eclampsia/eclampsia may be associated with exudative retinal detachment. No intervention is indicated, provided hypertension is controlled, prognosis is usually good.

OTHER NOTES

N/A

ABBREVIATIONS

RRD = rhegmatogenous retinal detachment
PVD = posterior vitreous detachment
PVR = proliferative vitreoretinopathy

Clinical Investigations
  • Cardiology
  • Dermatology
  • General Destistry
  • Cardiology
  • Dermatology

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.

Facebook X-twitter Instagram Google-plus-g
QUICK LINKS
contact

Copyright © 2025 Selkey. All Rights Reserved.