Retinal detachment happens when the light-sensing retina separates from the back wall of the eye, most often after a retinal tear lets fluid seep underneath. It is an emergency because the longer the macula stays detached, the worse the final vision.
Key symptoms
- Sudden new floaters
- Flashes of light (photopsia)
- A dark shadow or curtain spreading across the vision
- Painless blurred vision
- Risk factors: high myopia, older age, eye surgery, trauma
What you find on exam
- Visual acuity: normal if the macula is attached, reduced if detached
- Confrontation visual fields: field loss matching the curtain
- Relative afferent pupillary defect if the detachment is large
- Fundoscopy: gray, raised, folded retina
- Pigment cells in the vitreous on slit lamp (tobacco dust)
Tests
- Dilated fundus exam by an ophthalmologist
- Bedside ocular ultrasound if the retina cannot be seen
- Optical coherence tomography to check the macula
Treatment basics
- Same-day ophthalmology referral
- Laser or cryotherapy to seal a tear before it detaches
- Pneumatic retinopexy with a gas bubble for selected detachments
- Vitrectomy or scleral buckle surgery
- Head positioning after gas and no air travel until the gas is gone
Red flags
- Curtain moving toward the center of the vision
- Sudden drop in visual acuity
- Detachment after penetrating eye trauma
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.