Ocular Dz 4: Retinal Breaks & Detachments

Front 1

It's a full-thickness defect (tear/hole/split) in the sensory retina which may occur with or without detachment of the retina

Back 1

retinal break

Front 2

It's a separation of the photoreceptors from the underlying RPE.

Back 2

retinal detachment

Front 3

What are the 3 main types of retinal detachment (RD)?

Back 3

1. Rhegmatogenous RD
- tear in the retina

2. Tractional RD
- pulling out from the RPE

3. Exudative RD
- fluid in the RPE

Front 4

A specific type of RD which occurs when a retinal break allows liquefied vitreous to seep into the potential space between the NSR & RPE.

Back 4

Rhegmatogenous RD

Front 5

Formation of a Rhegmatogenous RD requires what 3 things?

Back 5

1. A FULL thickness retinal break
2. Traction holding the break open
3. Liquefied vitreous

Front 6

What are some CAUSES of retinal breaks?

Back 6

- Mechanical tearing: something can "tug" on the retina, ripping it.
- Atrophic hole formation: the retina itself can degenerate (wither away)

Front 7

What are some examples of retinal breaks?

Back 7

1. Posterior Vitreous Detachment (PVD)
2. Trauma
3. Developmental/Degenerative abnormalities
4. Traction induced by fibrovascular proliferation (Ex: Diabetic Retinopathy)

Front 8

This is a normal age-related process, whereby vitreous gel liquefies over time
- Probably due to accumulated toxic effects of light irradiation and metabolic waste products
- Will happen in ALL eyes eventually
- Usually WITHOUT causing RD!

Back 8

Vitreal Synchysis

Front 9

Refers to a normal age-related process, whereby the solid vitreous gel collapses/contracts forward while liquid fills retrohyaloid space

Back 9

Posterior Vitreous Detachment (PVD)

Front 10

PVD is accompanied by what 2 characteristics?

Back 10

1. Synchysis
- liquefaction of vitreous

2. Syneresis
- shrinkage or contraction of vitreous

Front 11

Pt c/o of:
1) Flashes (photopsia)
- it's observed when retina is tugged on as gel pulls away

2) Floaters
- observed when moving vitreous opacities cast a shadow on the retina:

1. Single large floater (Weiss Ring)
2. Cobwebs (condensation of collagen fibers)
3. Shower of small dark spots (RBC's)

Signs:
1. Easier to see Weiss Ring
2. Vitreous hemorrhage
3. Difficult but not impossible to observe detached/condensed vitreous gel at slit lamp

What's the Dx & Tx?

Back 11

a) Posterior Vitreous Detachment (PVD)

b) Tx:
1. Must rule out RD in symptomatic patients
- Careful DFE
- Look for associated signs/symptoms of RD

2. Monitor closely while "flashes" persist

3. Reassurance
- NO cure for annoying floaters
- will become LESS noticeable over time

Front 12

What are some SYMPTOMS of RD?

Back 12

1. NOT all patients are symptomatic!
2. Majority of spontaneous cases notice "flashes" and/or floaters with preceding PVD.
- "Flashes" may disappear if a piece of retina (operculum) tears away completely
3. A "curtain" or "shadow" in vision may be seen to progress centrally
- initially location signals that of primary retinal break

Front 13

What are some SIGNS of RD?

Back 13

1. RAPD may be present if RD is extensive
2. IOP may be slightly LOWER than fellow eye
3. Mild iritis is common
4. Pigment cells in anterior vitreous
- Shafer's sign or "tabacco dust"
5. Retinal Breaks
- most often found in superotemporal quadrant
- may appear as complete/incomplete flap tears, operculated tears, dialysis, holes

Front 14

What's the major clinical differences between a fresh RD vs long-standing RD?

Back 14

a) Fresh RD
- Elevated retina has a translucent appearance
- Appears "wrinkled"
- Seen to undulate with eye movements

b) Long-standing RD
- Detached retina becomes thinned & atrophied
- Intraretinal cysts may form
- Demarcation lines

Front 15

Pt c/o:
- Flashes
- Floaters
- A "curtain"/"shadow" in central vision

Signs:
- RAPD
- Lower IOP in affected eye
- Mild iritis
- Shafer's sign/Tabacco dust = pigment cells in anterior vitreous

What's the Dx and Tx?

Back 15

a) Retinal Detachment

b) Tx:
1. Most RD's will progress to severe permanent vision loss without treatment
2. Successful reattachment depends on permanent closure of retinal breaks responsible in a timely fashion
3. Reattachment techniques will be discussed in detail by retinal specialist
- Pneumatic retinopexy (gas bubble tamponade
- Scleral Buckling (with/without fluid drainage)

Front 16

What are some diagnostic methods for Rhegmatogenous RD?

Back 16

1. Suspicion should be aroused when typical symptoms are described
2. Evaluation must include careful DFE w/BIO
- Scleral indentation may be appropriate
3. B-scans useful when media opacities obscure view
4. Slit-lamp lenses may be helpful