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Retinal Detachment PDF Print E-mail
Definition
Retinal detachment (RD) occurs with separation of the neurosensory retina from the retinal pigment epithelium (RPE).

Etiology
Bilateral retinal detachment (RD) suggest a systemic problem. Optic nerve colobomas, severe retinal dysplasia, systemic hypertension due to renal or cardiac failure, intraocular neoplasia and choriorenitis may cause retinal detachment (RD).

Pathophysiology
The neurosensory retina may by pushed away from the retinal pigment epithelium (RPE) by acumulation of chorioretinal space (exudative retinal detachment), or it may be torn and pulled away from the retinal pigment epithelium (RPE) by vitreal traction from vitreal inflammation or hemorraghe (rhegmatogenous retinal detachment).

Clinical presentation/signs
  • Blindness or reduced vision
  • Dilated pupil with slow or no pupillary light reflex
  • Blood vessels or a membrane is usually observed easily through the pupil just behind the lens.
  • Vitreous abnormalities, liquefaction, hemorrhage, or syneresis (liquefaction); common
  • Interruption or alteration of the course of blood vessels owing to retinal elevation
  • With clear subretinal fluid, vessels may cast shadows on the tapetum or retinal pigment epithelium (RPE).
  • Depend on any underlying systemic diseases

Differential Diagnosis
  • Ophthalmic examination usually sufficient for diagnosis
  • Blindness or impaired vision optic neuritis; glaucoma; cataracts; progressive retinal atrophy; SARDS; CNS disease
  • Dilated pupil with slow or absent pupillary light reflexes glaucoma, oculomotor nerve lesion; optic neuritis; progressive retinal atrophy, SARDS
  • Membrane or vessels associated with or behind lens persistent tunica vasculosa lentis; persistent pupillary membranes, fibrovascular membrane secondary to intraocular neoplasia or inflammation

Diagnosis
Ophthalmic examination reveals dilated pupils (if bilateral), blood vessels located bbehind the lens, leucopenia, vitreous degeneration and or hemorrhage and an opaque, folded retina. Ocular ultrasound is diagnostic for retinal detachment (RD) in eyes with cataract.

Treatment
  • Depend on underlying systemic causes, which should be identified and treated appropriately
  • Systemic prednisone, 2 mg/kg divided q12h for 3-10 days, then taper, if systemic mycosis is ruled out and the detachment is believed to be immune-mediated, may facilitate retinal reattachment, for immune-mediated disease, taper medications very slowly over months.
  • Antiinflammatory doses of prednisone 0.5 mg/kg, then taper, may be useful for exudative detachments of an infectious nature as long as the underlying disease is being definitively treated

Management/Prevention
  • Depends on the physical condition of the patient
  • Usually outpatient
  • Acute blindness, vision may be restored if the underlying cause is rapidly identified and treated, make every attempt to determine the cause.
  • Degeneration occurs rapidly, provide therapy, whether surgical or medical, as soon as possible after diagnosis.
  • Rhegmatogenous, an ophthalmologist may be able to provide surgical treatment.

Tags:  Article Pets Animals Retinal Detachment
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