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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.
Introduction
  • 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
  • Prognosis
    • vision typically salvaged if the detachment does not extend across the macula
    • great outcomes with treatment
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

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EXPERT COMMENTS (7)
Private Note