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retinal pigment epithelium detachment (retinal detachment)

Etiology: 1) trauma 2) may occur spontaneously 3) risk factors a) diabetic retinopathy (proliferative stage) b) transient monocular blindness (TMB) or amaurosis fugax c) Marfan's syndrome d) fluoroquinolones increase risk [4] e) occurs mainly in myopic persons [2] Epidemiology: - persons age 50-75 years of age Pathology: - separation of the inner layers of the retina (neural retina) from the pigment epithelium & choroid - posterior vitreous detachment (most common) Clinical manifestations: 1) acute visual loss (lasting > 1 hour) 2) rapid increase in number of visual floaters 3) flashes, flashing lights, unilateral photopsia [2,3] 4) painless 5) metamorphopsia (squiggly lines or wavy distortion of central vision) 6) normal conjunctiva & cornea 7) normal pupil 8) sudden peripheral visual field defect [2,5] - may appear as a black curtain that progresses across the visual field [2,5] 9) symptoms may progress over 1 week to 3 months [2] Special laboratory: - ophthalmoscopy - distortion, folding & tearing of the retina [2] - wide-field retinal photography Complications: - blindness [2] Differential diagnosis: - posterior vitreous detachment - floaters may be described as 'cobweb' - flashing lights also seen - can lead to retinal detachment - central retinal artery occlusion - abrupt, profound, painless vision loss in one eye, only gross movements seen - afferent pupillary defect is present - funduscopy showa retinal paleness due to ischemic changes - central retinal vein occlusion - sudden onset of unilateral vision loss - afferent pupillary defect may be present - funduscopy shows scattered, diffuse retinal hemorrhages +/- optic disc edema Management: - immediate referral to ophthalmology

Related

retina vitreous detachment

Specific

rhegmatogenous retinal detachment autosomal dominant

General

retinal disease

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  4. Etminan M e al Oral Fluoroquinolones and the Risk of Retinal Detachment JAMA. 2012;307(13):1414-1419 PMID: 22474205 http://jama.ama-assn.org/content/307/13/1414.short
  5. Magauran B. Conditions requiring emergency ophthalmologic consultation. Emerg Med Clin North Am. 2008 Feb;26(1):233-8 PMID: 18249265
  6. Hollands H, Johnson D, Brox AC, Almeida D, Simel DL, Sharma S. Acute-onset floaters and flashes: is this patient at risk for retinal detachment? JAMA. 2009 Nov 25;302(20):2243-9 PMID: 19934426
  7. Lee E, Dogramaci M, Williamson T. Displacement of the retina. Ophthalmology. 2012 Jan;119(1):206.e1; PMID: 22214956
  8. Kwok JM, Yu CW, Christakis PG. Retinal detachment. CMAJ. 2020;192:E312. PMID: 32392514
  9. National Eye Institute: Retinal Detachment http://www.nei.nih.gov/health/retinaldetach/index.asp