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39 Cards in this Set
- Front
- Back
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What are the symptoms of a retinal detachment? |
• Any sudden onset of or an increase in the number of floaters (tobacco dust) • Any sudden shower of floaters like small insects • Any sudden onset flashes of light or a change in the pattern of flashes normally seen or flashes of light that do not go away • Any sudden change in vision • Any loss of peripheral vision when one eye is covered • The appearance of a curtain or discolouration over your vision |
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What is a retinal detachment? |
Separation of the neurosensory retina from the retinal pigment epithelium (RPE) by subretinal fluid (SRF) |
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What are the three types of retinal detachment? |
Tractional • Detachment of vitreous by fibro-proliferative strands Exudative or serous • Accumulation of fluid under retina without an associated retinal break Rhegmatogenous • Accumulation of liquefied vitreous / fluid under retina following a retinal break |
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What is a tractional detachment? |
When scar tissue or other tissue grows on your retina and pulls it away from the layer underneath. |
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What are the symptoms of tractional retinal detachment? |
Usually asymptomatic unless encroaching on posterior pole Sudden abrupt loss of visual acuity |
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What are the signs of a retinal detachment? |
Vitreal strands and membranes Concave, smooth-surfaced detachment Dense and immobile detachment RAPD Visual field defect |
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What is the managment of a tractional retinal detachment? |
Needs emergency referral to eye casualty, normally ring eye casualty and send direct that day |
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What are exudative retinal detachments (rare) associated with? |
• Occur in association with subretinal disorders that damage the RPE layer |
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List some sub-retinal disorders associated with exudative retinal detachments |
• choroidal neoplasms • posterior scleritis • congenital optic disc anomalies (optic pits, morning glory syndrome) • Coat's disease |
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Where is SRF derived from? |
SRF derived from choriocappiliaris |
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What are the symptoms of a exudative retinal detachment? |
• Photopsiae ( flashing lights) are not usually noticed • May have sudden visual field defect • Metamorphopsia if near to fovea |
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How prevalent is rhegmatogenous retinal detachment? |
• 1:10,000 of the population each year • Both eyes involved 10% -Not at the same time |
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What is rhegmatogenous retinal detachment caused by? |
• Dynamic vitreoretinal traction • Predisposing retinal degeneration • High myopia |
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What are the predisposing retinal detachments? |
• Lattice degeneration • Retinal thinning – involves a dropout of peripheral capillaries resulting (due to ischaemia) in thinning of retinal layers • Overlying area of vitreous liquefaction (vitreous is abnormal) |
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How does a lattice degeneration appear? |
Appears as a linear track circumferentially |
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What is the pathogenesis of rhegmatogenous retinal detachment? |
Posterior vitreous detachment (PVD) |
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What is Proliferative Vitreoretinopathy caused by? |
Caused by contraction of the membranes of the inner retinal surface (epiretinal membranes ERM) |
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What are the clinical signs of Proliferative Vitreoretinopathy? |
Clinical sign are retinal folds |
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What are the different types of retinal break? |
Horseshoe or U-shaped tear Operculated Atrophic hole Dialysis • Involves splitting of vitreous base • Usually infero-temporal • Can be spontaneous or traumatic Macular hole • Idiopathic; myopia; Commotio retinae |
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What are operculated retinal holes? |
• Round red hole with associated floating plug of tissue • May be surrounded by cuff of whitish oedema • The fresher the break the more likely the development of retinal detachment |
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What is the management of operculated retinal holes? |
• Symptomatic – same day referral • Asymptomatic- review 6 months |
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What is an atrophic retinal hole? |
• A round retinal break without accompanying vitreo-retinal traction • Present in 2-3% of the population • May be surrounded by cuff of whitish oedema or pigment • Fewer than 7% of atrophic holes develop into retinal detachment |
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What is the management for Atrophic Retinal Holes? |
• Keep in mind that retinal detachment may occur • An isolated, asymptomatic atrophic retinal hole with no associated cuff of oedema - review in 12 months – ENSURE that patient is educated correctly regarding symptoms of retinal detachment and comment in your notes you have done so • Any atrophic hole with cuff of oedema and associated symptoms should be same day referral • If in any doubt - Refer |
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What are the risk factors of RD? |
•Increased age • Myopia (High) • Acute PVD • Family history of a retinal detachment or break • Previous retinal detachment or break • History of recent trauma, surgery or inflammation • Predisposing conditions • Vitreoretinal degenerations |
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What are the symptoms of retinal detachment? |
• Photopsia More noticeable with eye movements and in dim illumination Projected into temporal peripheral field most commonly • Floaters Shadow in field of vision 60% of patients with RD have ALL symptoms Round asymptomatic holes may be associated with asymptomatic retinal detachments in young myopia |
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What should be questioned if floaters are reported? |
• Recent or long-standing -Last day, week,month significant? • Which eye? • What do they look like? • How many are there? • Any flashes? • Any shadows, curtains? |
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What should be questioned if photopsia (flashes) are reported? |
• For symptoms of flashes these additional questions should be asked: • Describe the flashes? • How long do they last? • Which eye? • When do you notice them? |
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What will be identified on patient examination for a retinal detachment? |
• V/A Normal unless macular detached or SRF approaching macula •Visual fields Peripheral Maybe normal • Pupil reactions RAPD may be present • Low IOP 5mmHg in affected eye Mild anterior uveitis • Peripheral retinal evaluation Dilated fundus examination Super field or SuperVitreo • Pigment or blood in anterior vitreous • Shafer’s sign • Symptoms of flashing lights and/or floaters of recent onset • Suspect retinal tear/detachment • Dilated pupil • Direct focal illumination • Pigment cells in vitreous sensitivity 95.8%, specificity 100% (Tanner et al 2000) for RD/ tear |
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What will be seen of patient examination of a retinal detachment? |
Slightly opaque & corrugated • Convex configuration and a slightly opaque • Loss of the underlying choroidal pattern • Retinal blood vessels appear darker than in flat • Out of focus compared to flat retina |
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What is the aetiology of a RD? |
• Retinal & RPE atrophy “ High water mark” – RPE hyperplasia • Viscous subretinal fluid • Intraretinal cyst formation • Proliferative vitreoretinopathy • Rubeosis iridis • Phthisis bulbi (shrunken eye) |
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Which symptoms of a retinal detachment require same day referral? |
Symptoms requiring same day referral • Sudden increase in number of floaters, patient may report as "numerous", “too many to count" or “sudden shower or cloud of floaters” • Cloud, curtain or veil over the vision • Retinal detachment with good vision • Vitreous or pre-retinal haemorrhage • Pigment 'tobacco dust' in anterior vitreous • Retinal tear/hole with symptoms |
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Which signs require referral ASAP; next available clinic appointment (Ring eye casualty for advice)? |
• Retinal detachment with poor vision (macula off) • Retinal hole/tear without symptoms • Lattice degeneration with symptoms of recent • flashes and/or floaters? Check for PVD first! |
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What will require discharge with SOS advice (verbal advice and a leaflet)? |
• Uncomplicated PVD without signs and symptoms listed previously • Signs of lattice degeneration without symptoms listed previously |
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What is the treatment for a RD? |
Localisation & closure of breaks • Relief of vitreoretinal traction • Buckling or vitrectomy • Neuroretinal-RPE adhesion • Scleral buckle Photocoagulation or cryotherapy • Internal tamponade • Air; longer acting gases; Silicone oil |
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What is Retinoschisis? |
• Splits or cysts within the neurosensory retina •Retinoschisis can be: Primary Senile (level of OPL) Juvenile/congenital (level of RNFL) Secondary to other conditions -Trauma, proliferative retinopathies, vitreous traction |
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Describe senile retinoschisis |
• Bilateral in 33% • Usually infero-temporal • Usually hyperopic • Dome elevation of inner • retinal layers • White dots (snowflakes) on inner limiting membrane • Inner leaf has beaten metal appearance • Sheathing of peripheral vessels • Round holes can occur in inner leaf • Larger holes can occur in outer leaf • 1% progress to rhegmatogenous RD • Peripheral field defect though onen asymptomatic • Need periodic observation with visual fields • Education |
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What is juvenile Retinoschisis? |
• X-linked recessive • Splits in NFL • Bilateral • Foveal (cystoid changes BUT not CMO) or peripheral • Associated with systemic diseases • Poor visual prognosis • Predisposes to RD, esp infero-temporally |
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What is the differential diagnosis of RD and Retinoschisis? |
• Px Exam Symmetrical location no pigment cells in vitreous • Scotoma Absolute with Retinoschisis, relative scotoma with RD • OCT imaging |
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What is important to remember for a retinal detachment/ presence of floaters? |
Floaters are a common symptom in optometric practice Floaters and or flashes may indicate a PVD or an RD • Most are PVD • RD’s are sight threatening • Visualisation of full retina is difficult you must dilate these Px’s • Missed RD – common cause of litigation! • If unsure take advice from a colleague or refer to HES !! |
