Retinal Detachment

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Retinal detachment is a medical emergency in which the retina, the light-sensitive layer at the back of the eye, separates from the underlying supportive tissue. This separation can lead to permanent vision loss if not treated promptly.

Aetiology

Retinal detachment can occur due to various factors, including:

• Rhegmatogenous detachment: Caused by a tear or break in the retina, allowing fluid to accumulate underneath
• Tractional detachment: Occurs when scar tissue on the retina's surface contracts, pulling the retina away from the back of the eye
• Exudative detachment: Caused by inflammation or injury leading to fluid buildup beneath the retina without a tear or break

Pathophysiology

In retinal detachment, the separation of the retina from the underlying retinal pigment epithelium (RPE) disrupts the blood supply to the retina, leading to a loss of retinal function. The type of detachment (rhegmatogenous, tractional, or exudative) determines the underlying mechanism and treatment approach.

Risk Factors

• High myopia (nearsightedness)
• Previous eye surgery (e.g., cataract surgery)
• Previous retinal detachment in the other eye
• Family history of retinal detachment
• Eye injury or trauma
• Retinal diseases (e.g., lattice degeneration)
• Diabetes (risk of tractional detachment)

Signs and Symptoms

Common signs and symptoms of retinal detachment include:

• Sudden appearance of floaters (small dark spots or lines in the field of vision)
• Flashes of light (photopsia)
• A shadow or curtain over part of the visual field
• Sudden decrease in vision

Investigations

• Clinical history and physical examination
• Ophthalmoscopy to examine the retina
• Ultrasound imaging of the eye if the view is obstructed (e.g., by blood or cataract)
• Optical coherence tomography (OCT) to assess the extent of detachment

Management

Primary Care Management

• Immediate referral to an ophthalmologist: Retinal detachment is a medical emergency
• Instruct the patient to avoid activities that might worsen the detachment (e.g., heavy lifting, bending over)

Specialist Management

• Surgical interventions:
  • Laser photocoagulation: Laser is used to create burns around the retinal tear to seal it and prevent detachment
  • Cryopexy: Freezing treatment to create a scar that helps reattach the retina
  • Pneumatic retinopexy: A gas bubble is injected into the vitreous cavity to push the retina back into place
  • Scleral buckling: A silicone band is placed around the eye to push the wall of the eye against the detached retina
  • Vitrectomy: Surgical removal of the vitreous gel and replacement with a gas bubble, silicone oil, or saline solution
• Post-operative care and monitoring to ensure successful reattachment and detect any complications

References

1. NICE. (2024). Retinal Detachment: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Retinal Detachment. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Retinal Detachment: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Retinal Detachment. Retrieved from AAO

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