Retinal detachment
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Retinal detachment is the separation of the neurosensory retina from the underlying retinal pigment epithelium, leading to vision loss if untreated.
Aetiology
- Rhegmatogenous detachment: caused by a retinal tear or break, allowing vitreous fluid to accumulate beneath the retina.
- Tractional detachment: due to fibrovascular bands pulling the retina away, often seen in diabetic retinopathy.
- Exudative detachment: secondary to fluid accumulation without a retinal tear, seen in inflammatory or neoplastic conditions.
Pathophysiology
- Retinal separation disrupts photoreceptor function, leading to visual field defects.
- Prolonged detachment results in irreversible retinal damage due to ischaemia and atrophy.
- Rhegmatogenous detachment is the most common type, often linked to posterior vitreous detachment.
Risk Factors
- Myopia (increased axial length predisposes to retinal tears).
- Previous ocular surgery (e.g., cataract surgery).
- Trauma.
- Family history of retinal detachment.
- Diabetic retinopathy.
Signs and Symptoms
- Flashes of light (photopsia): due to retinal traction.
- Floaters: perception of dark specks or cobweb-like shadows.
- Progressive visual field loss: often described as a curtain descending over vision.
- Painless vision loss: central vision is affected if the macula detaches.
Investigations
- Fundoscopy: direct visualisation of the detached retina.
- Slit-lamp examination with scleral depression: identifies peripheral retinal breaks.
- OCT (optical coherence tomography): assesses macular involvement.
Management
1. Urgent Ophthalmic Referral:
- All suspected cases require same day ophthalmology assessment.
2. Surgical Management:
- Vitrectomy: removal of vitreous to allow retinal reattachment.
- Scleral buckling: external indentation to support the retina.
- Pneumatic retinopexy: intraocular gas bubble to tamponade the break.
3. Postoperative Care:
- Positioning (e.g., face down) depending on surgical approach.
- Avoid strenuous activities to prevent recurrence.
- Regular follow-up for monitoring visual recovery.
4. Referral:
- Ophthalmology: immediate referral for all cases.
- Diabetology: if related to diabetic retinopathy.
- Genetics: if hereditary predisposition is suspected.