Retinal Detachment

Retinal Detachment is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 3 types with common final pathway:
    • Rhegmatogenous retinal detachments (RRD)
    • Tractional retinal detachments (TRD)
    • Exudative retinal detachments (ERD)
  • RRD:
    • Most common
    • Break or tear of sensory retina allows vitreous fluid to separate the sensory and pigmented parts of retina from each other
    • Acute event, flashes secondary to tearing of nerve fibers, floaters secondary to bleeding
  • TRD:
    • Contraction of fibrous vitreous bands, as a result of previous insult, pulls the sensory retina off the pigmented retina
    • Chronic and progressive
    • Asymptomatic unless hemorrhage or retinal tear occurs
  • ERD:
    • Subretinal fluid accumulates and separate retinal layers without violating either layer
    • Do not usually require surgery
    • Usually secondary systemic disease such as severe acute hypertension, sarcoid, cancer

Etiology

  • RRD:
    • Myopia
    • Cataract surgery
    • Marfan syndrome
    • Structural degeneration of underlying anatomy of vitreous body, sensory or pigmented retina
    • Trauma
  • TRD:
    • Proliferative diabetic retinopathy
    • Vasculopathy
    • Perforating injury
    • Chorioretinitis:
      • Retinopathy of prematurity, sickle cell disease, or toxocariasis
    • Trauma
  • ERD:
    • Malignant hypertension, preeclampsia
    • Tumors of the choroid or retina (melanoma, retinoblastoma)
    • Inflammatory disorders (Coats or Harada disease, posterior scleritis)

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Basics

Description

  • 3 types with common final pathway:
    • Rhegmatogenous retinal detachments (RRD)
    • Tractional retinal detachments (TRD)
    • Exudative retinal detachments (ERD)
  • RRD:
    • Most common
    • Break or tear of sensory retina allows vitreous fluid to separate the sensory and pigmented parts of retina from each other
    • Acute event, flashes secondary to tearing of nerve fibers, floaters secondary to bleeding
  • TRD:
    • Contraction of fibrous vitreous bands, as a result of previous insult, pulls the sensory retina off the pigmented retina
    • Chronic and progressive
    • Asymptomatic unless hemorrhage or retinal tear occurs
  • ERD:
    • Subretinal fluid accumulates and separate retinal layers without violating either layer
    • Do not usually require surgery
    • Usually secondary systemic disease such as severe acute hypertension, sarcoid, cancer

Etiology

  • RRD:
    • Myopia
    • Cataract surgery
    • Marfan syndrome
    • Structural degeneration of underlying anatomy of vitreous body, sensory or pigmented retina
    • Trauma
  • TRD:
    • Proliferative diabetic retinopathy
    • Vasculopathy
    • Perforating injury
    • Chorioretinitis:
      • Retinopathy of prematurity, sickle cell disease, or toxocariasis
    • Trauma
  • ERD:
    • Malignant hypertension, preeclampsia
    • Tumors of the choroid or retina (melanoma, retinoblastoma)
    • Inflammatory disorders (Coats or Harada disease, posterior scleritis)

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