Retinal Detachment

Key clinical points

• Rhegmatogenous detachment results from a retinal tear or hole; tractional and exudative types have other mechanisms.
• New flashes, a shower of floaters, or a progressing curtain over the vision are urgent symptoms.
• Macula-on detachments warrant prompt repair to protect central vision.
• Risk factors include high myopia, prior cataract surgery, trauma, and lattice degeneration.
• Repair options include laser/cryopexy for tears and pneumatic retinopexy, scleral buckle, or vitrectomy for detachment.

Types

Rhegmatogenous retinal detachment, the most common form, occurs when a retinal break allows liquefied vitreous to pass beneath the retina. Tractional detachment results from contracting fibrovascular membranes, as in advanced diabetic retinopathy. Exudative detachment arises from fluid accumulation due to inflammatory, vascular, or neoplastic processes without a retinal break.

Symptoms and risk factors

Classic symptoms are the sudden onset of flashes of light, a marked increase in floaters, and a progressing curtain or shadow across the visual field. A posterior vitreous detachment with these symptoms warrants prompt dilated examination to detect a retinal break before detachment progresses.

Risk factors include high myopia, aphakia or pseudophakia, ocular trauma, lattice degeneration, and a history of detachment in the fellow eye.

Management

Retinal tears without detachment are treated with laser retinopexy or cryotherapy to seal the break. Established detachment is repaired surgically: pneumatic retinopexy, scleral buckling, or pars plana vitrectomy, chosen according to the configuration and complexity of the detachment.

Visual prognosis depends heavily on whether the macula was still attached at the time of repair, which is why macula-on detachments are prioritized for urgent surgery.