Retinal detachment - Revision history

Danbot: Strip excess bold

2026-03-22T09:36:05Z

Strip excess bold

← Older revision		Revision as of 09:36, 22 March 2026
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	*'''Ophthalmologic emergency''' — requires urgent referral; macula-off detachments should be repaired within 24-72 hours		*'''Ophthalmologic emergency''' — requires urgent referral; macula-off detachments should be repaired within 24-72 hours
	*Three types:		*Three types:
	**~~'''~~Rhegmatogenous~~'''~~ (most common) — tear/break allows vitreous fluid under retina		**Rhegmatogenous (most common) — tear/break allows vitreous fluid under retina
	**~~'''~~Tractional~~'''~~ — fibrous bands pull retina (diabetic retinopathy, sickle cell)		**Tractional — fibrous bands pull retina (diabetic retinopathy, sickle cell)
	**~~'''~~Exudative~~'''~~ — fluid accumulation without a break (inflammation, tumor)		**Exudative — fluid accumulation without a break (inflammation, tumor)
	*Annual incidence: ~1 in 10,000<ref name="haimann">Haimann MH, et al. Epidemiology of retinal detachment. ''Arch Ophthalmol''. 1982;100(2):289-292. PMID 7065948.</ref>		*Annual incidence: ~1 in 10,000<ref name="haimann">Haimann MH, et al. Epidemiology of retinal detachment. ''Arch Ophthalmol''. 1982;100(2):289-292. PMID 7065948.</ref>

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	==Clinical Features==		==Clinical Features==
	*~~'''~~Painless~~'''~~ visual symptoms (pain suggests alternative diagnosis)		*Painless visual symptoms (pain suggests alternative diagnosis)
	*~~'''~~Photopsia~~'''~~ — flashing lights (traction on retina)		*Photopsia — flashing lights (traction on retina)
	*~~'''~~Floaters~~'''~~ — sudden onset or dramatic increase		*Floaters — sudden onset or dramatic increase
	*~~'''~~Visual field deficit~~'''~~ — described as a "curtain" or "shadow" moving across vision		*Visual field deficit — described as a "curtain" or "shadow" moving across vision
	*Decreased visual acuity if macula involved (macula-off detachment)		*Decreased visual acuity if macula involved (macula-off detachment)
	*~~'''~~Shafer sign~~'''~~ (tobacco dust / pigment in anterior vitreous) is pathognomonic on slit lamp		*Shafer sign (tobacco dust / pigment in anterior vitreous) is pathognomonic on slit lamp

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*~~'''~~Bedside ocular ultrasound~~'''~~ — high sensitivity (97%) for detecting retinal detachment<ref name="blaivas">Blaivas M, et al. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. ''Acad Emerg Med''. 2005;12(9):844-849. PMID 16141018.</ref>		*Bedside ocular ultrasound — high sensitivity (97%) for detecting retinal detachment<ref name="blaivas">Blaivas M, et al. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. ''Acad Emerg Med''. 2005;12(9):844-849. PMID 16141018.</ref>
	**Undulating membrane tethered to the optic disc (distinguishes from posterior vitreous detachment)		**Undulating membrane tethered to the optic disc (distinguishes from posterior vitreous detachment)
	*~~'''~~Fundoscopic exam~~'''~~: retinal elevation, tears, or folds		*Fundoscopic exam: retinal elevation, tears, or folds
	**May be difficult to visualize in ED without pupil dilation		**May be difficult to visualize in ED without pupil dilation
	*~~'''~~Visual acuity~~'''~~ — document in all patients		*Visual acuity — document in all patients
	*~~'''~~Pupil exam~~'''~~ — [[Relative afferent pupillary defect\|APD]] may be present		*Pupil exam — [[Relative afferent pupillary defect\|APD]] may be present

	==Management==		==Management==
	*~~'''~~Emergent ophthalmology consultation~~'''~~		*Emergent ophthalmology consultation
	**Macula-on detachment: repair within 24 hours (to preserve central vision)		**Macula-on detachment: repair within 24 hours (to preserve central vision)
	**Macula-off detachment: repair within 24-72 hours; outcomes less time-sensitive		**Macula-off detachment: repair within 24-72 hours; outcomes less time-sensitive
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	*If a superior detachment, position patient upright (to slow progression)		*If a superior detachment, position patient upright (to slow progression)
	*If inferior detachment, supine positioning		*If inferior detachment, supine positioning
	*~~'''~~No specific ED treatment~~'''~~ will reverse detachment — definitive repair is surgical		*No specific ED treatment will reverse detachment — definitive repair is surgical
	*Surgical options (for ophthalmology): pneumatic retinopexy, scleral buckle, vitrectomy		*Surgical options (for ophthalmology): pneumatic retinopexy, scleral buckle, vitrectomy

Danbot: Major expansion: types, risk factors, POCUS evaluation, disposition guidance, references

2026-03-21T18:32:16Z

Major expansion: types, risk factors, POCUS evaluation, disposition guidance, references

← Older revision		Revision as of 18:32, 21 March 2026
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	==Background==		==Background==
	~~[[File~~:~~A Retinal Detachment~~.~~jpg\|thumb\|Retinal detachement]]~~		*Separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE)
	~~[[File~~:~~Ocular~~ - ~~Retinal detachment~~.~~gif\|thumb]]~~		*'''Ophthalmologic emergency''' — requires urgent referral; macula-off detachments should be repaired within 24-72 hours
	*Average age of onset ~55		*Three types:
			**'''Rhegmatogenous''' (most common) — tear/break allows vitreous fluid under retina
			**'''Tractional''' — fibrous bands pull retina (diabetic retinopathy, sickle cell)
			**'''Exudative''' — fluid accumulation without a break (inflammation, tumor)
			*Annual incidence: ~1 in 10,000<ref name="haimann">Haimann MH, et al. Epidemiology of retinal detachment. ''Arch Ophthalmol''. 1982;100(2):289-292. PMID 7065948.</ref>

	==~~=Types=~~==		==Risk Factors==
	~~#Rhegmatogenous~~ (~~rhegma means "tear"~~)		*Myopia (nearsightedness) — strongest risk factor
	~~#*As vitreous separates from retina the traction creates a hole in retina~~		*Prior cataract surgery
	~~#**Fluid goes through the hole and peels the retina off like wallpaper~~		*Trauma (blunt or penetrating)
	~~#Exudative~~
	~~#*Fluid accumulates beneath the retina without a retinal tear~~
	~~#*Associated with neoplasm, inflammatory conditions, [[hypertension]], [[preeclampsia]]~~
	~~#Tractional~~
	~~#*Acquired fibrocellular bands in the vitrous contract and detach the retina~~
	~~#*Associated with [[DM]], [[sickle cell]], [[facial trauma\|trauma]]~~
	~~#Distinguish between mac-off and mac-on~~

	~~===Other~~ risk ~~factors===~~
	*~~Aging~~
	*~~Previous retinal detachment~~
	*Family history of retinal detachment		*Family history of retinal detachment
	*~~Extreme myopia~~		*Prior retinal detachment in fellow eye
	*~~Eye surgery, cataract removals~~		*Lattice degeneration
			*Age >50 (posterior vitreous detachment)

	==Clinical Features==		==Clinical Features==
	*~~Abrupt onset of new [[Acute onset flashers and floaters\|"floaters" or flashes of light]]~~		*'''Painless''' visual symptoms (pain suggests alternative diagnosis)
	**Vitreous tugs on ~~the~~ retina ~~before separation~~		*'''Photopsia''' — flashing lights (traction on retina)
	*~~[[vision loss\|Visual acuity loss]] (filmy, cloudy,~~ or ~~curtain-like) or [[visual field defects\|visual field]] loss~~		*'''Floaters''' — sudden onset or dramatic increase
	**May be mild or ~~dramatic~~		*'''Visual field deficit''' — described as a "curtain" or "shadow" moving across vision
	*~~[[Fundoscopic exam]] with dilation~~		*Decreased visual acuity if macula involved (macula-off detachment)
	**On fundoscopy, elevated retina will appear hazy gray and out of focus		*'''Shafer sign''' (tobacco dust / pigment in anterior vitreous) is pathognomonic on slit lamp

	==Differential Diagnosis==		==Differential Diagnosis==
	~~{{Acute vision loss noninflamed DDX}}~~		*[[Posterior vitreous detachment]] (most common cause of flashes/floaters; benign)
			*[[Vitreous hemorrhage]]
	{{Acute ~~onset flashers and floaters DDX}}~~		*[[Central retinal artery occlusion]]
			*[[Central retinal vein occlusion]]
			*[[Optic neuritis]]
			*[[Migraine]] with visual aura
			*[[Acute angle-closure glaucoma]]

	==Evaluation==		==Evaluation==
	~~[[File:RetinalDetachment.jpeg\|thumbnail]]~~		*'''Bedside ocular ultrasound''' — high sensitivity (97%) for detecting retinal detachment<ref name="blaivas">Blaivas M, et al. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. ''Acad Emerg Med''. 2005;12(9):844-849. PMID 16141018.</ref>
	*~~[[Ocular~~ ultrasound]] (~~LR+ 12, LR– 0.27~~)<ref>~~Kim DJ, Francispragasam~~ M~~, Docherty G~~, et al. ~~Test Characteristics~~ of ~~Point-of-care Ultrasound~~ for the ~~Diagnosis~~ of ~~Retinal Detachment in the Emergency Department~~. Acad Emerg Med. ~~2019~~;26(1):16-22.</ref>		**Undulating membrane tethered to the optic disc (distinguishes from posterior vitreous detachment)
	**~~Generally remains anchored~~ to the optic disc ~~in most~~ posterior ~~section of the eye~~		*'''Fundoscopic exam''': retinal elevation, tears, or folds
	**~~Appears as a hyperechoic membrane floating~~ in ~~the vitreous chamber~~		**May be difficult to visualize in ED without pupil dilation
	*There are many studies out there confirming high sensitivity/specificity, recent study showing 94% sensitive/96% specific when performed by radiology and 92% sensitive/91% specific when performed by emergency providers<ref>Point-of-care ocular ultrasound for the diagnosis of retinal detachment: a systematic review and meta-analysis Gottlieb M, Holladay D, Peksa GD. Acad Emerg Med. 2019;26(8):931-939.</ref>		*'''Visual acuity''' — document in all patients
			*'''Pupil exam''' — [[Relative afferent pupillary defect\|APD]] may be present

	==Management==		==Management==
	*~~Position patient relative to area of retinal detachment so retina lies flat:~~		*'''Emergent ophthalmology consultation'''
	**~~Superior~~ detachment ~~= lay patient's head in supine position~~		**Macula-on detachment: repair within 24 hours (to preserve central vision)
	**~~Inferior~~ detachment ~~= elevate head up~~		**Macula-off detachment: repair within 24-72 hours; outcomes less time-sensitive
	**~~Different from face-down recovery~~ position ~~after pneumatic retinopexy~~ (~~so that bubble covers retinal break~~)		*Restrict activity and avoid Valsalva maneuvers
	**~~May know where retinal~~ detachment is ~~by a couple of clues:~~		*If a superior detachment, position patient upright (to slow progression)
	***Good fundoscopy		*If inferior detachment, supine positioning
	***US beam orientation		*'''No specific ED treatment''' will reverse detachment — definitive repair is surgical
	***[[Visual Field Defects]] examples<ref>Gariano RF and Kim CH. Evaluation and Management of Suspected Retinal Detachment. Am Fam Physician. 2004 Apr 1;69(7):~~1691-1699.</ref>:~~		*Surgical options (for ophthalmology): pneumatic retinopexy, scleral buckle, vitrectomy
	****Superior detachment may have inferior visual field defect
	****Temporal detachment may have nasal visual field defect

	==Disposition==		==Disposition==
	*~~Most~~ likely ~~admit vs~~ same-day ~~(immediate) referral to~~ retinal ~~surgeon (minutes may matter)~~		*Emergent ophthalmology referral for all suspected retinal detachments
			*Macula-on: same-day evaluation and likely same-day repair
			*Macula-off: urgent repair within days; outpatient if ophthalmology comfortable
			*Posterior vitreous detachment without retinal break: outpatient ophthalmology follow-up within 1-2 weeks

	==See Also==		==See Also==
	*[[Acute ~~Onset Flashers and Floaters~~]]		*[[Posterior vitreous detachment]]
	*[[~~Ocular ultrasound~~]]		*[[Vitreous hemorrhage]]
			*[[Central retinal artery occlusion]]
			*[[Acute angle-closure glaucoma]]
			*[[Eye emergencies]]

	==References==		==References==

Gpowellhb: /* Evaluation */

2020-02-20T19:48:46Z

Evaluation

← Older revision		Revision as of 19:48, 20 February 2020
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	**Generally remains anchored to the optic disc in most posterior section of the eye		**Generally remains anchored to the optic disc in most posterior section of the eye
	**Appears as a hyperechoic membrane floating in the vitreous chamber		**Appears as a hyperechoic membrane floating in the vitreous chamber
			*There are many studies out there confirming high sensitivity/specificity, recent study showing 94% sensitive/96% specific when performed by radiology and 92% sensitive/91% specific when performed by emergency providers<ref>Point-of-care ocular ultrasound for the diagnosis of retinal detachment: a systematic review and meta-analysis Gottlieb M, Holladay D, Peksa GD. Acad Emerg Med. 2019;26(8):931-939.</ref>

	==Management==		==Management==

ClaireLewis: /* Clinical Features */

2019-10-06T21:44:49Z

Clinical Features

← Older revision		Revision as of 21:44, 6 October 2019
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	*Abrupt onset of new [[Acute onset flashers and floaters\|"floaters" or flashes of light]]		*Abrupt onset of new [[Acute onset flashers and floaters\|"floaters" or flashes of light]]
	**Vitreous tugs on the retina before separation		**Vitreous tugs on the retina before separation
	*[[vision loss\|Visual acuity loss]] (filmy, cloudy, or curtain-like) or visual field loss		*[[vision loss\|Visual acuity loss]] (filmy, cloudy, or curtain-like) or [[visual field defects\|visual field]] loss
	**May be mild or dramatic		**May be mild or dramatic
	*[[Fundoscopic exam]] with dilation		*[[Fundoscopic exam]] with dilation

ClaireLewis at 21:44, 6 October 2019

2019-10-06T21:44:03Z

← Older revision		Revision as of 21:44, 6 October 2019
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	#Exudative		#Exudative
	#*Fluid accumulates beneath the retina without a retinal tear		#*Fluid accumulates beneath the retina without a retinal tear
	#*Associated with neoplasm, inflammatory conditions, hypertension, preeclampsia		#*Associated with neoplasm, inflammatory conditions, [[hypertension]], [[preeclampsia]]
	#Tractional		#Tractional
	#*Acquired fibrocellular bands in the vitrous contract and detach the retina		#*Acquired fibrocellular bands in the vitrous contract and detach the retina
	#*Associated with DM, sickle cell, trauma		#*Associated with [[DM]], [[sickle cell]], [[facial trauma\|trauma]]
	#Distinguish between mac-off and mac-on		#Distinguish between mac-off and mac-on

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	*Abrupt onset of new [[Acute onset flashers and floaters\|"floaters" or flashes of light]]		*Abrupt onset of new [[Acute onset flashers and floaters\|"floaters" or flashes of light]]
	**Vitreous tugs on the retina before separation		**Vitreous tugs on the retina before separation
	*Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss		*[[vision loss\|Visual acuity loss]] (filmy, cloudy, or curtain-like) or visual field loss
	**May be mild or dramatic		**May be mild or dramatic
			*[[Fundoscopic exam]] with dilation
			**On fundoscopy, elevated retina will appear hazy gray and out of focus

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	[[File:RetinalDetachment.jpeg\|thumbnail]]		[[File:RetinalDetachment.jpeg\|thumbnail]]
	*~~Examination~~		*[[Ocular ultrasound]] (LR+ 12, LR– 0.27)<ref>Kim DJ, Francispragasam M, Docherty G, et al. Test Characteristics of Point-of-care Ultrasound for the Diagnosis of Retinal Detachment in the Emergency Department. Acad Emerg Med. 2019;26(1):16-22.</ref>
	**Visual acuity and visual fields
	**Fundoscopic exam with dilation
	**On fundoscopy, elevated retina will appear hazy gray and out of focus
	*Ocular ~~POCUS~~ (LR+ 12, LR– 0.27)<ref>Kim DJ, Francispragasam M, Docherty G, et al. Test Characteristics of Point-of-care Ultrasound for the Diagnosis of Retinal Detachment in the Emergency Department. Acad Emerg Med. 2019;26(1):16-22.</ref>
	**Generally remains anchored to the optic disc in most posterior section of the eye		**Generally remains anchored to the optic disc in most posterior section of the eye
	**Appears as a hyperechoic membrane floating in the vitreous chamber		**Appears as a hyperechoic membrane floating in the vitreous chamber

Kearny89: /* Evaluation */

2019-06-15T07:36:48Z

Evaluation

← Older revision		Revision as of 07:36, 15 June 2019
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	**Fundoscopic exam with dilation		**Fundoscopic exam with dilation
	**On fundoscopy, elevated retina will appear hazy gray and out of focus		**On fundoscopy, elevated retina will appear hazy gray and out of focus
	*Ocular ~~ultrasound~~		*Ocular POCUS (LR+ 12, LR– 0.27)<ref>Kim DJ, Francispragasam M, Docherty G, et al. Test Characteristics of Point-of-care Ultrasound for the Diagnosis of Retinal Detachment in the Emergency Department. Acad Emerg Med. 2019;26(1):16-22.</ref>
	**Generally remains anchored to the optic disc in most posterior section of the eye		**Generally remains anchored to the optic disc in most posterior section of the eye
	**Appears as a hyperechoic membrane floating in the vitreous chamber		**Appears as a hyperechoic membrane floating in the vitreous chamber

Kxl328: /* Evaluation */

2018-10-10T22:47:12Z

Evaluation

← Older revision		Revision as of 22:47, 10 October 2018
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	**Visual acuity and visual fields		**Visual acuity and visual fields
	**Fundoscopic exam with dilation		**Fundoscopic exam with dilation
			**On fundoscopy, elevated retina will appear hazy gray and out of focus
	*Ocular ultrasound		*Ocular ultrasound
	**Generally remains anchored to the optic disc in most posterior section of the eye		**Generally remains anchored to the optic disc in most posterior section of the eye

Kxl328: /* Clinical Features */

2018-10-10T22:46:55Z

Clinical Features

← Older revision		Revision as of 22:46, 10 October 2018
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	*Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss		*Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss
	**May be mild or dramatic		**May be mild or dramatic
	*On fundoscopy, elevated retina will appear hazy gray and out of focus

	==Differential Diagnosis==		==Differential Diagnosis==

Kxl328: /* Clinical Features */

2018-10-10T22:46:27Z

Clinical Features

← Older revision		Revision as of 22:46, 10 October 2018
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	**Vitreous tugs on the retina before separation		**Vitreous tugs on the retina before separation
	*Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss		*Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss
	**May be mild or dramatic		**May be mild or dramatic
			*On fundoscopy, elevated retina will appear hazy gray and out of focus

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Acute vision loss noninflamed DDX}}		{{Acute vision loss noninflamed DDX}}

Rossdonaldson1: /* Disposition */

2017-09-14T05:31:36Z

Disposition

← Older revision		Revision as of 05:31, 14 September 2017
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	==Disposition==		==Disposition==
	*~~Urgent ophtho~~ referral ~~within 24hr~~ (~~pneumatic retinopexy, scleral buckle, or vitrectomy~~)~~<ref>Illinois Retina and Eye Associates. Retinal Detachment. 2009. http://www.illinoisretinainstitute.com/index.php?p=1_11.</ref>~~		*Most likely admit vs same-day (immediate) referral to retinal surgeon (minutes may matter)
	**In macular off retinal detachment, visual acute is significantly decreased if reattachment does not occur within 6 days. <ref>Diederen R et al: Scleral buckling surgery after macula-off retinal detachment: Worse visual outcome after more than 6 days. Ophthalmology 2007; 114:705-709</ref>

	==See Also==		==See Also==