Ophthalmology Book

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Retinal DetachmentAka: Detached Retina

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  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
    2. Gariano (2004) Am Fam Physician 69:1691

Retinal Detachment (C0035305)

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.
ConceptsDisease or Syndrome (T047)
ICD9361.9
MSHD012163
BasqueERRETINAREN DESPRENDIMENTUA
DanishNethindelosning
DutchNetvlies loslating
EnglishDetached retina, DETACHMENT RETINAL, RD - Retinal detachment, retina detachment, RETINAL DETACHMENT, Retinal Detachments, Sensory retinal detachment, Unspecified retinal detachment
FinnishVERKKOKALVON IRTOAMINEN
FrenchDecollement de la retine
GermanNetzhautabloesung
Hebrewhafradat rishtit
Hungarianretinalevalas
ItalianDistacco di retina
NorwegianNETTHINNEAVLOSNING
PortugueseDescolamento da retina
SpanishDesprendimiento de retina, desprendimiento retiniano
SwedishNATHINNEAVLOSNING
Parent ConceptsRetinal Diseases (C0035309), RETINAL ABNORMALITY (C0035300), Retinal detachments and defects (C1533659), Eye (C0015392), Diagnosis/Diseases Component (C0497531), Retinal Detachment (C0035305), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, CST, DXP, ICD9CM, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, LCH, MSH, MTH, NCI, NDFRT, OMIM, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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