I. Epidemiology

  1. Incidence (U.S.): one in 10,000 to 15,000 per year (most over age 50 years old)
  2. Lifetime risk: 1 in 300 patients

II. Pathophysiology

  1. Retina detaches from underlying epithelium
  2. Types and associated causes
    1. Rhegmatogenous Retinal Detachment (most common)
      1. Posterior Vitreous Detachment is initiating event (confers 10-15% risk of progression to Retinal Detachment)
      2. Common age >50-60 years old (with related increased traction at vitreous attachments)
      3. Vitreous pulls on Retina causing brief flashing lights (Photopsias)
      4. Vitreous Detachment will result in shadows forming on the Retina (visual Floaters)
    2. Exudative or serous Retinal Detachment
      1. Sarcoid Uveitis
      2. Severe Hypertension
      3. Neoplasm
    3. Tractional Retinal Detachment
      1. Fibrosis due to trauma or retinopathy

III. Risk Factors

  1. Most common risks
    1. Myopia (Near-sightedness, due to egg-shaped globe)
      1. Myopia with >3 diopter Refractive Error confers 10x increased risk
    2. Eye Trauma
    3. Coagulopathy
    4. Older age (especially age > 60 years)
    5. Prior Cataract surgery (decreases vitreous): 1% risk
  2. Other risk factors
    1. Diabetic Retinopathy
    2. Retinopathy of Prematurity
    3. Congenital Cataracts
    4. Congenital Glaucoma
    5. Retinal Detachment Family History

IV. Symptoms

  1. Classic triad: Flashes, Floaters and visual field defect
  2. Unilateral Photopsia (Light Flashes)
    1. Occurs with vitreous pulling on the Retina (see above)
  3. Unilateral increase in number of Floaters
    1. Occurs with Vitreous Detachment (see above)
  4. Acute, painless Vision Loss
    1. Develops peripherally and progresses centrally
    2. Develops over a course of hours to days
    3. Ultimately may involve the macula at which point prognosis is significantly worse for vision in the affected eye
  5. Altered visual field
    1. Shadow or curtain sensation falls over affected eye
    2. Metamorphopsia (wavy distortion of vision)

V. Signs

  1. Funduscopic Exam with Pupil Dilation (direct and indirect)
    1. Careful exam by a skilled examiner focused on the peripheral Retina

VI. Differential Diagnosis

  1. See Floaters (Entopsias)
  2. See Flashing Lights (Photopsias)
  3. See Acute Vision Loss

VII. Imaging

  1. Ophthalmic Ultrasonography
    1. Indicated if Ophthalmoscopy is non-diagnostic

VIII. Management

  1. Emergent, immediate ophthalmology referral
    1. Normal Visual Acuity with suspected new Retinal Detachment confers a higher urgency to maintain that Visual Acuity
  2. Ophthalmology management
    1. Retina fixed in place (pneumatic retinopexy)
      1. Air or gas injected into the vitreous cavity (holds Retina in place) and forces out trapped fluid beneath the Retinal tear
    2. Reattachment of Retina
      1. Ophthalmologist locates the Retinal tear
      2. Cryotherapy, diathermy or laser photocoagulation applied to Retinal tear to reattach, or tack down the Retina
    3. Reduce vitreous tension at attachment to Retina (may not be required)
      1. Scleral buckling involves the suturing of constricting band to Sclera to decrease globe diameter, and hence vitreous traction
    4. Other measures indicated in more complex Retinal Detachments
      1. Posterior vitrectomy

IX. Prognosis (with surgical repair)

  1. Good prognosis for 20/40 vision or better in 75% of cases unless central macula involvement

X. Complications

  1. Proliferative vitreoretinopathy
    1. Fibrosis forms within weeks of repair
  2. Retinal Detachment in contralateral eye (25% risk)

XI. Prevention

  1. Sports Eye Protection
  2. Posterior Vitreous Detachment
    1. May require laser "tacking" of Retina
    2. Aggressively follow patients with new onset
    3. Higher risk if increase in Floaters present
  3. Contralateral eye Retinal Detachment
    1. Periodic Eye Exams by ophthalmology in those with Retinal Detachment history

Images: Related links to external sites (from Google)

Ontology: Retinal Detachment (C0035305)

Definition (NCI) An eye emergency condition which may lead to blindness if left untreated. It is characterized by the separation of the inner retina layers from the underlying pigment epithelium. Causes include trauma, advanced diabetes mellitus, high myopia, and choroid tumors. Symptoms include sudden appearance of floaters, sudden light flushes, and blurred vision.
Definition (NCI) A disorder characterized by the separation of the inner retina layers from the underlying pigment epithelium.
Definition (MSH) Separation of the inner layers of the retina (neural retina) from the pigment epithelium. Retinal detachment occurs more commonly in men than in women, in eyes with degenerative myopia, in aging and in aphakia. It may occur after an uncomplicated cataract extraction, but it is seen more often if vitreous humor has been lost during surgery. (Dorland, 27th ed; Newell, Ophthalmology: Principles and Concepts, 7th ed, p310-12).
Definition (CSP) separation of the inner layers of the retina from the pigment epithelium.
Concepts Disease or Syndrome (T047)
MSH D012163
ICD9 361.9
ICD10 H33.2
SnomedCT 42059000, 155103005, 193347002
English RETINA DETACHMENT, Detachment, Retinal, Detachments, Retinal, Retinal Detachments, Unspecified retinal detachment, RETINA, DETACHMENT, DETACHMENT RETINAL, RETINA, SEPARATION, RETINAL DETACHMENT, retina detachment, Retinal detachment, NOS, Retinal detachment NOS, Retina Detachment, Sensory retinal detachment, RETINA, CONGENITAL NONATTACHMENT OF, Retinal Detachment, retinal detachment, retinal detachment (physical finding), detached retina, retinal detachment (diagnosis), Detachment retinal, Retinal detachment NOS (disorder), RETINA, DETACHED, DETACHED RETINA, Retinal Detachment [Disease/Finding], retinal detachments, Detachment;retinal, retina detached, Retinal detachment, RD - Retinal detachment, Detached retina, Retinal detachment (disorder), detachment; retina, retina; detachment, Amotio retinae
German NETZHAUTABLOESUNG, Abloesung der Netzhaut, abgeloeste Netzhaut, unspezifische Netzhautabloesung, Amotio retinae, Netzhautabloesung, Ablatio retinae, Netzhautablösung
Italian Distacco retinico, Distacco di retina, Distacco retinico non specificato, Distacco della retina
Dutch amotio retinae, niet-gespecificeerde retinaloslating, losgelaten retina, loslating retina, Netvlies loslating, loslating; retina, retina; loslating, retinaloslating, Ablatio retinae, Netvliesloslating
French Rétine décollée, Décollement de la rétine (amotio retinae), Décollement rétinien non précisé, DECOLLEMENT DE LA RETINE, Decollement de la retine, Décollement de la rétine, Décollement rétinien
Portuguese Amotio retinae (descolamento da retina), Descolamento da retina NE, Retina descolada, DESCOLAMENTO DA RETINA, Descolamento de Retina, Descolamento da retina, Descolamento do Epitélio Pigmentar da Retina, Descolamento Retiniano
Spanish Desprendimiento retiniano, Desprendimiento de retina no especificado, Amotio retinae, Retinal detachment, RETINA, DESPRENDIMIENTO, desprendimiento de retina (trastorno), desprendimiento de retina, SAI (trastorno), desprendimiento de retina, SAI, desprendimiento de retina, desprendimiento retiniano, Desprendimiento de retina, Desprendimiento de Retina
Japanese 網膜剥離, 詳細不明の網膜剥離, モウマクハクリ, ショウサイフメイノモウマクハクリ
Swedish Näthinneavlossning, NATHINNEAVLOSNING
Czech retina - odchlípení, Odchlípená sítnice, Amotio retinae, Odchlípení sítnice, Blíže neurčené retinální odchlípení
Finnish Verkkokalvon irtauma, VERKKOKALVON IRTOAMINEN
Russian SETCHATKI OTSLOIKA, PIGMENTNOGO EPITELIIA SETCHATKI OTSLOIKA, ПИГМЕНТНОГО ЭПИТЕЛИЯ СЕТЧАТКИ ОТСЛОЙКА, СЕТЧАТКИ ОТСЛОЙКА
Norwegian NETTHINNEAVLOSNING
Danish Nethindelosning
Hungarian retinalevalas, Retina leválás, Levált retina, Nem meghatározott retinaleválás, Retinaleválás, Ideghártya-leválás
Croatian RETINALNA ABLACIJA
Basque ERRETINAREN DESPRENDIMENTUA
Hebrew hafradat rishtit
Polish Odwarstwienie siatkówki