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Retinal Detachment
Aka: Retinal Detachment, Detached Retina
- Epidemiology
- Incidence (U.S.): one in 10,000 per year
- Lifetime risk: 1 in 300 patients
- Pathophysiology
- Retina detaches from underlying epithelium
- Types and associated causes
- Exudative or serous Retinal Detachment
- Sarcoid Uveitis
- Severe Hypertension
- Neoplasm
- Tractional Retinal Detachment
- Fibrosis due to trauma or retinopathy
- Rhegmatogenous Retinal Detachment (most common)
- Posterior Vitreous Detachment (confers 10-15% risk)
- Common age >60 years
- Risk Factors
- Most common risks
- Myopia (Near-sightedness, due to egg-shaped globe)
- Eye Trauma
- Coagulopathy
- Older age (especially age > 60 years)
- Prior Cataract surgery (decreases vitreous): 1% risk
- Other risk factors
- Diabetic Retinopathy
- Retinopathy of Prematurity
- Congenital Cataracts
- Congenital Glaucoma
- Retinal Detachment Family History
- Symptoms
- Acute, painless Vision Loss
- Develops peripherally and progresses centrally
- Develops over a course of hours or longer
- Shadow or curtain sensation falls over affected eye
- Unilateral Photopsia (Light Flashes seen)
- Metamorphopsia (wavy distortion of vision)
- Unilateral increase in n umber of Floaters
- Signs
- Ophthalmoscope may not show lesion
- Differential Diagnosis
- See Floaters (Entopsias)
- See Flashing Lights (Photopsias)
- See Acute Vision Loss
- Imaging
- Ophthalmic Ultrasonography
- Indicated if Ophthalmoscopy is non-diagnostic
- Management
- Immediate ophthalmology referral
- Procedures
- Scleral buckling
- Posterior vitrectomy
- Pneumatic retinopexy
- Prognosis (with surgical repair)
- Good prognosis unless central macula involvement
- Complications
- Proliferative vitreoretinopathy
- Fibrosis forms within weeks of repair
- Prevention
- Sports Eye Protection
- Posterior Vitreous Detachment
- May require laser "tacking" of Retina
- Aggressively follow patients with new onset
- Higher risk if increase in Floaters present
- References
- Banker (2001) Ophthalmol Clin North Am 14(4):695-704
- Gariano (2004) Am Fam Physician 69:1691-8