What are the signs of retinal detachment and how is it treated?

Signs and Treatment of Retinal Detachment

Retinal detachment is an ophthalmologic emergency requiring immediate referral to an ophthalmologist on the same day symptoms appear to prevent permanent vision loss. 1

Key Signs and Symptoms

Warning Signs

• Flashes of light (photopsias) - typically most noticeable in dark environments, caused by vitreous traction on the retina
• Floaters (myodesopias) - may be due to:
  • Blood from torn retinal vessels
  • Condensations of vitreous collagen
  • Epipapillary glial tissue (Weiss ring) torn from optic nerve head
• Peripheral visual field loss - often described as a "dark curtain" or shadow
• Decreased visual acuity - especially if the macula becomes involved

Risk Factors

• Advanced age (typically 45-65 years)
• Previous cataract surgery
• Myopia
• History of trauma
• Previous retinal breaks or detachment in fellow eye
• Family history of retinal detachment

Diagnostic Approach

Critical Examination Components

1. Visual acuity measurement
2. Vitreous evaluation - looking for:
   • Pigment cells (tobacco dust)
   • Hemorrhage
   • Vitreous syneresis
3. Peripheral fundus examination using:
   • Scleral depression
   • Fundus contact or non-contact lens with slit-lamp biomicroscopy
4. B-scan ultrasonography when media is opaque 2

Red Flags Requiring Immediate Referral

• Vitreous hemorrhage
• Pigmented cells in vitreous
• Any retinal break identified
• Sudden onset of multiple floaters
• Flash and floater combination

Treatment Approaches

For Retinal Breaks (Pre-detachment)

1. Laser photocoagulation

   • Creates chorioretinal adhesion around breaks
   • Extends to ora serrata for horseshoe tears
   • Reduces risk of progression to detachment to <5% 2

2. Cryotherapy

   • Alternative to laser for creating chorioretinal adhesion
   • Particularly useful when media opacity prevents laser treatment

For Established Retinal Detachment

1. Scleral buckle

   • Success rate approximately 77-78% 3

2. Pars plana vitrectomy

   • Success rate approximately 80% 3
   • Often combined with gas or silicone oil tamponade
   • Note: Leads to progressive nuclear cataract in majority of phakic patients 2

3. Combined approaches

   • Vitrectomy with scleral buckle for complex cases

Post-Treatment Follow-up

• Examination on postoperative day 1
• Follow-up at 1-2 weeks after surgery
• Additional follow-up if new symptoms develop
• Patient education on symptoms of recurrent detachment 2

Important Considerations

Prognosis Factors

• Early intervention is critical - preserves macular attachment and visual outcomes
• Anatomical success rates range from 85-90% 1
• Even with successful anatomical repair, visual outcomes depend on macular involvement

Complications of Treatment

• Retinal breaks during vitrectomy (approximately 1% with modern techniques)
• Retinal detachment after vitrectomy (1-3.5% depending on technique)
• Endophthalmitis (<0.05% of vitrectomies)
• Macular hole formation
• Cataract progression in >70% of phakic patients after vitrectomy 2

Patient Education

Patients should be instructed to contact their ophthalmologist immediately if they experience:

• Increase in floaters
• New flashes of light
• Loss of visual field
• Decrease in visual acuity 2

Remember that between 8-22% of patients with acute posterior vitreous detachment symptoms have a retinal tear at initial examination, making prompt evaluation essential for preventing vision loss 2.