Retinal Detachment

1. Epidemiology
   1. Incidence (U.S.): one in 10,000 per year
   2. Lifetime risk: 1 in 300 patients
2. Pathophysiology
   1. Retina detaches from underlying epithelium
   2. Types and associated causes
      1. Exudative or serous Retinal Detachment
         1. Sarcoid Uveitis
         2. Severe Hypertension
         3. Neoplasm
      2. Tractional Retinal Detachment
         1. Fibrosis due to trauma or retinopathy
      3. Rhegmatogenous Retinal Detachment (most common)
         1. Posterior Vitreous Detachment (confers 10-15% risk)
         2. Common age >60 years
3. Risk Factors
   1. Most common risks
      1. Myopia (Near-sightedness, due to egg-shaped globe)
      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
4. Symptoms
   1. Acute, painless Vision Loss
      1. Develops peripherally and progresses centrally
      2. Develops over a course of hours or longer
   2. Shadow or curtain sensation falls over affected eye
   3. Unilateral Photopsia (Light Flashes seen)
   4. Metamorphopsia (wavy distortion of vision)
   5. Unilateral increase in n umber of Floaters
5. Signs
   1. Ophthalmoscope may not show lesion
6. Differential Diagnosis
   1. See Floaters (Entopsias)
   2. See Flashing Lights (Photopsias)
   3. See Acute Vision Loss
7. Imaging
   1. Ophthalmic ultrasonography
      1. Indicated if Ophthalmoscopy is non-diagnostic
8. Management
   1. Immediate ophthalmology referral
   2. Procedures
      1. Scleral buckling
      2. Posterior vitrectomy
      3. Pneumatic retinopexy
9. Prognosis (with surgical repair)
   1. Good prognosis unless central macula involvement
10. Complications
    1. Proliferative vitreoretinopathy
       1. Fibrosis forms within weeks of repair
11. 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
12. References
    1. Banker (2001) Ophthalmol Clin North Am 14(4):695-704
    2. Gariano (2004) Am Fam Physician 69:1691-8