67 y/o male with acute onset, unilateral visual changes
Patient will present as → a 65-year-old man complaining of a sudden unilateral vision loss which he describes as "a curtain or dark cloud lowering over my eye." This was preceded by small moving flashing lights, and floaters. The fundoscopic exam reveals a detached superior retina.
To watch this and all of Joe Gilboy PA-C's video lessons you must be a member. Members can log in here or join now.
Retinal detachment is a separation of the neurosensory retina from the underlying retinal pigment epithelium. The most common cause is a retinal tear (rhegmatogenous detachment)
- If a patient complains of the new onset of floaters or flashes of light, the patient should undergo a dilated eye exam to rule out a retinal tear or retinal detachment
- Classically described as "a curtain or dark cloud lowering over my eye"
- Sudden and painless
- Often is spontaneous, but may have an underlying cause – for example, recent cataract surgery
- Myopia (nearsightedness) is a risk factor for the development of retinal detachment
- Retinal detachment usually presents with defects in the peripheral visual field
Diagnosis is by fundoscopy
- Retinal detachment is visualized on fundoscopy as an irregular elevation of the retina with crinkling of retinal tissue and changes in vessel direction
- Ultrasonography may help determine the presence and type of retinal detachment if it cannot be seen with funduscopy
- If there is no obvious vitreous abnormality, consider CT/MRI and/or neurologic consultation as well
Retinal detachment is an ophthalmologic emergency
- Stay supine (lying face upward) with head turned towards the side of the detached retina
- Pneumatic retinopexy is a procedure for the management of retinal detachment that involves cryoretinopexy followed by injection of an air bubble in the vitreous
A detached retina is caused by an accumulation of fluid leading to the separation of the sensory retina and underlying pigment epithelium. Symptoms may include flashes of light, floaters, and a curtain-like shadow. Interventions for retinal detachment include promoting bed rest, avoiding vigorous activity, wearing an eye patch, and preparing for immediate surgical repair.
Play Video + QuizQuestion 1 |
Central retinal vein occlusion Hint: Central retinal vein occlusion causes painless, variable loss of vision. Exam shows retinal hemorrhages in all quadrants and edema of the optic disk. | |
Retinal artery occlusion Hint: Retinal artery occlusion presents with sudden, painless loss of vision. Exam shows pale retina with normal macula, seen as a cherry-red spot. | |
Retinal detachment | |
Hyphema Hint: Hyphema is usually associated with trauma, and is a collection of blood in the anterior chamber |
Question 2 |
Central retinal vein occlusion Hint: Central retinal vein occlusion is characterized by sudden monocular visual loss on examination there would be disc swelling, venous engorgement, cotton-wool spots, and diffuse retinal hemorrhages. | |
Acute angle-closure glaucoma Hint: Acute angle-closure glaucoma is characterized by pain and blurred vision. On examination the eye is red, the cornea is steamy, and the pupil is moderately dilated and nonreactive to light. | |
Acute nongranulomatous anterior uveitis Hint: Acute nongranulomatous anterior uveitis presents with acute unilateral eye pain, redness, photophobia, and vision loss. | |
Serous retinal detachment |
|
List |
References: Merck Manual · UpToDate
