Can a traumatic retinal detachment present with flashes and floaters weeks after injury?

Traumatic Retinal Detachment and Delayed Symptom Presentation

Yes, traumatic retinal detachment can present with flashes and floaters weeks after the initial injury, and patients with a history of trauma should be evaluated urgently regardless of when symptoms appear. 1

Timing of Symptom Onset After Trauma

• Symptoms of posterior vitreous detachment (PVD) such as flashes and floaters may appear immediately after trauma OR develop within 6 weeks following the initial traumatic event 1
• The American Academy of Ophthalmology specifically recommends monitoring patients for new or changing symptoms for up to 6 weeks following trauma, as this is the critical period when retinal breaks may develop 1
• Trauma-induced PVD can occur at a younger age than typical age-related PVD, which normally occurs between ages 45-65 1

Risk Assessment for Traumatic vs. Non-Traumatic Detachment

• Patient history should specifically identify any interval history of eye trauma when evaluating new visual symptoms 2
• Both blunt trauma and penetrating eye injuries can precipitate PVD and subsequent retinal detachment 1
• Even in patients with acute onset of floaters without flashes, there is a 14-23% risk of having a retinal tear, with trauma being a significant risk factor 3

Clinical Evaluation Algorithm

1. Urgent ophthalmologic assessment is required regardless of timing since trauma 3

   • Between 8-22% of patients with acute PVD symptoms have a retinal tear at initial examination 1
   • Even without retinal breaks at initial exam, approximately 2% of patients develop breaks in the following weeks 2

2. Key examination components:

   • Visual acuity measurement 2
   • Vitreous evaluation (looking for pigment, hemorrhage, or syneresis) 2
   • Thorough peripheral fundus examination using scleral depression 2
   • B-scan ultrasonography when media opacity prevents direct visualization 2

3. Follow-up protocol:

   • All patients with trauma-related PVD should have follow-up examination within 6 weeks, even if initial exam is negative 1
   • This is particularly important for patients with any degree of vitreous pigment, vitreous/retinal hemorrhage, or visible vitreoretinal traction 2
   • Three new breaks (3.3% of all tears found) were identified only at follow-up in one study 4

Warning Signs Requiring Immediate Attention

• Patients should be advised to seek immediate care if they develop:
  • New or increased floaters 2
  • Light flashes 2
  • Peripheral visual field loss 2
  • Decreased visual acuity 2

Common Pitfalls to Avoid

• Don't dismiss delayed symptoms: The assumption that traumatic retinal detachment must occur immediately after injury is incorrect - symptoms can develop weeks later 1
• Don't overlook minimal symptoms: Even patients with only one or two floaters plus light flashes can have serious pathology - 37% of patients who eventually developed retinal detachment initially had only 1-3 floaters plus flashes 5
• Don't neglect follow-up: Follow-up examination is essential even when initial examination is normal, as new breaks can develop in the weeks following trauma 2, 4
• Don't underestimate floaters alone: While a subjective reduction in vision is strongly predictive of retinal breaks, patients presenting with floaters alone still harbored 26.7% of retinal breaks in one study 4