Retinal Detachment

Snapshot

• A 65-year-old woman presents to the emergency department due to seeing “a curtain coming down” in her field of vision. Prior to this event, she has been noticing flashing lights, as well as floaters. The fundus was assessed via slit-lamp.

Overview

• The retina take photons and converts them into neuronal impulses that go to the visual cortex
• Separation of the retina from the retinal pigment epithelium and choroid → retinal detachment
  • can be due to fluid accumulation between that space, or traction by the vitreous
  • separation → photoreceptor degeneration
    • choroidal circulation can’t supply the neurosensory retina
    • quick diagnosis and treatment is essential
• Risk factors 
  • myopia
  • cataract surgery
  • ocular trauma
• ocular inflammation

Pathophysiology

• Rhegmatogenous detachment
  • most common type of retinal detachment
  • due to retinal tear usually secondary to retinal traction by the vitreous
    • most commonly caused by posterior vitreous detachment
• Tractional detachment
  • when vitreous and retina have abnormally strong attachment, contraction pulls the retina
    • e.g., proliferative diabetic retinopathy
• Exudative detachment
  • fluid accumulation under the retina
• e.g., neoplasm, inflammation, and maculopathy

Presentation

• Symptoms
  • floaters
  • photopsia
  • vision impairment
• “curtain coming down”

Diagnosis

•  Ophthalmologic examination to assess the peripheral fundus
• via indirect ophthalmoscopy or slit-lamp

Treatment/Management

• Laser retinopexy
• Cryoretinopexy
• Pneumatic retinopexy
• Scleral buckle
• Vitrectomy