The retina is overlayed by the choroid and then the sclera most superficially.
When we have detachment of the retina, it means that there is detachment of the neurosensory tissue from the underlying retinal pigment epithelium (RPE).
The most common cause is a retinal tear, resulting in rhegmatogenous retinal detachment.
Detachment without a tear is referred to as non-rhegmatogenous retinal detachment.
⚠️ Risk factors
- Trauma
- Diabetic retinopathy
- Myopia - a high myopia (prescription over -6) is more of a risk factor.
- Increasing age
- Cataract surgery
😷 Presentation
- It is painless.
- Floaters as there are free RPE cells in the vitreous humour.
- Flashes due to a lack of traction on the retina.
- Progressive vision loss in the peripheries described as a shadow progressing to the centre like a vignette.
- Central vision loss if the macula is involved.
🔍 Investigations
Eye investigations:
- Fundoscopy - may appear normal if the tear is small. There may be a loss of red reflex and retinal folds may seem pale, opaque and wrinkled.
- Slit lamp
- Swinging light test may indicate relevant afferent pupillary defect if there is optic nerve involvement with the detachment.
🧰 Management
Urgent referral for any patient with new onset flashes and floaters.
Retinal tear management:
With retinal tears, the aim is to adhere the retina to the choroid.
We can do so using:
- Laser therapy
- Cryotherapy
Retinal detachment management:
The aim of retinal detachment treatment is to reattach the retina and reduce traction/pressure that may lead to a secondary detachment.
We can do so by:
- Vitrectomy - removing portion of the vitreous and replacing it with oil or gas.
- Scleral buckling - using silicone buckle to put pressure on the sclera such that the eye is indented and brings the choroid inwards to make contact with the retina once more.
- Pneumatic retinopexy - injection of gas bubble into the vitreous such that is flattens the retina against the choroid.
