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Retinal detachment (Risk factors (Previous detachment, Eye trauma, FH,…
Retinal detachment
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Aetiology
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Vascular
Abnormal neovascularisation (CRVO, BRVO, DM)
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Clinical
presentation
Floaters
Mobile dots, lines, haze
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Sudden painless loss of vision
Dark curtain/shadow, peripheral-central
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Diagnosis
Examination
CN examination
Reduced acuity, visual field defect,
RAPD if extensive with optic nerve involvement
External eye examination
Nil, unless trauma causative
Fundoscopy
Loss of red reflex, vitreal opacities,
detached pale/wrinkled retinal folds
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History
DH
Current meds, allergies
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PMH
CVD, DM, myopia, retinal vascular disease,
previous ocular infections/trauma, cataract surgery
SH
Occupation, driving, smoking, alcohol
PC/HPC
Sudden, painless loss of vision,
flashes/floaters, dark curtain
Complications
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Surgical complications
Cataract, glaucoma, endophthalmitis,
astigmatism, diplopia
Pathophysiology
Types
Rhegmatogenous
Commonest cause
Vitreous shrinks and separates from retinal surface, causing tear/break; traction allows fluid to enter and retinal detachment
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Tractional
Abnormal vasculature causes vitreal contraction, pulling
on the underlying retina; NO breaks
Mechanism
Separation of inner neurosensory retina from retinal pigment epithelium, allowing accumulation of fluid in subretina space
Progressive loss of vision and permenant loss if macula affected
Progressive field loss (opposite direction to detachment)
Flashes (retinal detachment) and floaters (vitreal detachment)
Management
Surgical
Cryotherapy
Indication: retinal tear/break
MOA: scar created between retina and pigment epithelium,
seals hole and prevents fluid access, prevents progression
Vitrectomy
Indication: detachment
MOA: relieves traction by removing vitreous attached
to the trinal breaks; gas/oil used to span and close break,
scar develops preventing more fluid entering
Laser therapy
Indication: retinal tear/break
MOA: scar created between retina and pigment epithelium,
seals hole and prevents fluid access, prevents progression
Scleral buckling
Indication: detachment
MOA: slceral buckle placed on scleral suface over retinal break,
indents the eye and wall to contact the detached retina
Pneumatic retinoplexy
Indcation: detachment
MOA: small expansile gas bubble injected into vitreal cavity, which expands; specific posturing allows bubble to position over the break and the retinal pigment epithelium to reattach
Conservative
Information, advice, support
ASAP to ophthalmology if new onset
Definition
Separation of inner neurosensory retina
from underlying retinal pigment epithelium,
with resulting fluid accumulation in subretinal space