Traumatic Retinal Detachment Definition
Traumatic retinal detachment is a retinal detachment that occurs following ocular trauma, where the history of trauma precedes the detachment, though no universally standardized definition exists in the literature. 1, 2
Core Definitional Elements
The diagnosis of traumatic retinal detachment relies on establishing a temporal and causal relationship between ocular trauma and subsequent retinal detachment, rather than specific epidemiologic criteria. 1
Key Diagnostic Components
- Temporal relationship: A documented history of ocular trauma that precedes the development of retinal detachment 1, 2
- Mechanism-based classification: The overwhelming majority of traumatic retinal detachments are rhegmatogenous in origin, meaning they result from full-thickness retinal breaks that allow fluid to pass from the vitreous cavity into the subretinal space 3, 4
- Specific trauma-associated features: Retinal dialysis (a crescentic peripheral retinal break at the ora serrata) is specifically associated with trauma 4
Pathophysiologic Mechanisms
Blunt Trauma Mechanisms
- Shockwave propagation through the retina produces high strain that can cause retinal breaks, particularly at the ora serrata 5
- Negative pressure develops around and anterior to the equator during eye decompression following impact, with pressures reaching -663 kPa, which pulls the retina away from supporting tissue 5
- Relative inertial motion between the retina and its supporting tissue extends the detachment after initial trauma 5
Anatomic Break Locations
- Vitreous base region: Retinal breaks are predominantly located within this area following trauma 3
- Sites of focal scleral impact: Direct impact zones can develop breaks 3
- Posterior vitreous avulsion sites: Trauma-induced posterior vitreous detachment can occur at younger ages than typical age-related PVD, leading to retinal breaks 6
Clinical Context and Importance
Accurate categorization as traumatic is critical because it:
- Triggers systematic search for occult coexistent traumatic pathology 1
- Affects prognosis and treatment approach for both eyes 1
- Influences insurance coverage and medical-legal determinations 1
- Provides essential epidemiologic data 1
Common Etiologies
- Work-related injuries in construction and manufacturing 2
- Sports-related trauma 2
- Explosive eye injuries 2
- Road traffic accidents 2
- Intraocular foreign bodies 2
- Self-injurious behavior in patients with autism spectrum disorder or trisomy 21 7
Diagnostic Approach
The diagnosis should be based on individual patient history and physical examination findings rather than population-based epidemiologic criteria alone. 1 Look specifically for:
- History of blunt or penetrating ocular trauma that altered vitreous or retinal structure 4
- Retinal dialysis at the ora serrata, which is pathognomonic for trauma 4
- Vitreous base tears as the predominant break location 3
- Timing: Traumatic detachments can occur immediately or develop years after the initial injury 4