Is retinal detachment a medical emergency?

Retinal Detachment: A True Ophthalmologic Emergency

Retinal detachment is an ophthalmologic emergency that requires immediate medical attention as it can potentially lead to permanent vision loss if not treated promptly. 1 This condition demands urgent evaluation by an ophthalmologist, ideally on the same day symptoms appear, to maximize the chances of preserving vision.

Types and Pathophysiology

Retinal detachment occurs in three main forms:

• Rhegmatogenous: Most common type, resulting from retinal breaks caused by vitreoretinal traction
• Tractional: Due to fibrovascular proliferation pulling the retina away
• Exudative: Caused by fluid accumulation beneath the retina

Clinical Presentation

Patients with retinal detachment typically present with:

• Light flashes (photopsias)
• Floaters (myodesopias)
• Peripheral visual field loss ("dark curtain")
• Blurred vision, especially if the macula becomes involved 2, 3

Risk Factors

• Advancing age (peak incidence between 55-59 years)
• Myopia (low myopia increases risk fourfold)
• Previous cataract surgery
• Trauma
• Genetic disorders (such as Stickler syndrome)
• Family history of retinal detachments 2

Diagnostic Approach

When a patient presents with symptoms suggestive of retinal detachment:

1. Immediate ophthalmologic referral: All patients with acute onset of flashes or floaters should be referred to an ophthalmologist on the same day 3, 4
2. Dilated funduscopic exam: Gold standard for diagnosis
3. Ocular ultrasound: Valuable alternative when funduscopic exam is not feasible due to vitreous hemorrhage or dense cataracts 1
4. Advanced imaging: OCT and B-scan can help elucidate the type of detachment and underlying causes 5

Management

The management of retinal detachment follows a time-sensitive approach:

For Symptomatic Retinal Breaks (Pre-detachment)

• Prompt treatment: Symptomatic retinal breaks with persistent vitreoretinal traction (horseshoe or flap tears) have at least a 50% risk of progressing to retinal detachment if untreated 6
• Intervention: Laser photocoagulation or cryotherapy to create chorioretinal adhesion reduces the risk of retinal detachment to less than 5% 6, 2

For Established Retinal Detachment

• Surgical intervention: Options include:
  • Scleral buckle
  • Pars plana vitrectomy
  • Combination of both approaches
• Timing is critical: The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, preserving visual acuity 2, 4
• Anatomical success rates: Generally 85-90% 4

Importance of Timely Intervention

Retinal detachment represents a true ophthalmologic emergency for several critical reasons:

1. Progressive vision loss: Without treatment, blindness in the affected eye may result 4
2. Macula preservation: Visual outcomes are significantly better when repair occurs before the macula detaches 6
3. High success rates with early intervention: More than 95% of uncomplicated rhegmatogenous retinal detachments can be successfully repaired when addressed promptly 6

Surgical Setting Considerations

While emergency intervention is critical, the surgical setting matters:

• Expert surgeons achieve similar primary anatomical success rates in both routine and emergency settings
• Non-expert surgeons achieve inferior anatomical results when performing surgery in emergency settings (81.6% vs. 88.3%) 7
• If possible, scheduling surgery with an experienced vitreoretinal surgeon may optimize outcomes without compromising results 7

Patient Education

Patients should be educated about:

• The emergency nature of their condition
• The importance of immediate medical attention
• Symptoms that warrant urgent re-evaluation (new flashes, floaters, or visual field defects)
• The need for follow-up care even after successful treatment

Retinal detachment represents one of the most time-sensitive conditions in ophthalmology, where hours can make the difference between preserved vision and permanent visual impairment.