Snapshot A 65-year-old man presents to the emergency department for worsening vision loss. He reports that prior to developing these symptoms, he noted some floaters, along with bright lights. Ophthalmologic examination demonstrates a pale retina along with a retinal tear. Overview Separation of the retina from the retinal pigment epithelium 3 types primary retinal detachment (rhegmatogenous detachment) secondary to a hole, tear, or break in the retina most common type secondary retinal detachment exudative retinal detachment accumulation of fluid un the subretinal space in patients with systemic disease tractional retinal detachment recurrent retinal detachment unsuccessful closure of the original retinal break Epidemiology Risk factors aging cataract surgery focal retinal atrophy myopia trauma diabetic retinopathy Marfan syndrome vitreous hemorrhage Pathophysiology Rhegmatogenous detachment entry of vitreous fluid into the subretinal space through a retinal break Exudative detachment entery of serous and/or hemorrhagic fluid into the subretinal space accomplished by systemic disease hydrostatic forces in hypertension inflammation (e.g., sarcoidosis) malignancy (e.g., choroidal melanoma) maculopathy (e.g., neovascularization in age-related macular degeneration) Tractional detachment mechanical forces on the retina proliferative diabetic retinopathy retinopathy of immaturity Presentation Symptoms increasing number of floaters photopsia bright flashes of light monocular visual loss dim "shadow" or "curtain" Physical retitina may appear pale tear may be seen Differential Migraine with aura differentiating factors patients typically have a throbbing headache dilated exam will show a normal retina Optic neuritis differentiating factors afferent pupilary defect ocular pain with movement optic nerve head edema Treatment Surgical pneumatic retinopexy indication treatment option for rhegmatogenous and tractional detachments scleral buckles indication treatment option for rhegmatogenous and tractional detachments pars plana vitrectomy indication treatment option for rhegmatogenous and tractional detachments Complications Permanent vision loss if not repaired Prognosis Vision typically salvaged if the detachment does not extend across the macula Great outcomes with treatment