PANCE Blueprint EENT (7%)

Retinal detachment (ReelDx + Lecture)


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 floatersThe fundoscopic exam reveals a detached superior retina.

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What are the hallmarks of retinal detachment?
Flashes of light, floaters, and painless, sudden vision loss with a curtain-like shadow are the hallmark symptoms of retinal detachment.

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

Picmonic Retinal Detachment


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 + Quiz

Question 1
A 59 year-old male complains of "flashing lights behind my eye" followed by sudden loss of vision, stating that it was "like a curtain across my eye." He denies trauma. He takes Glucophage for his diabetes mellitus and atenolol for his hypertension. He has no other complaints. On funduscopic exam, the retina appears to be out of focus. Which of the following is the most likely diagnosis?
Central retinal vein occlusion
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
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 is usually associated with trauma, and is a collection of blood in the anterior chamber
Question 1 Explanation: 
Patients with retinal detachment frequently complain of flashes of light or floaters that occur during traction on the retina as it detaches. This is followed by loss of vision. In small detachments, the retina may appear out of focus, but with larger detachments, a retinal fold may be identified.
Question 2
A 75 year-old patient with history of macular degeneration and hypertension presents with complaint of sudden onset of visual loss in the left eye. The patient denies pain. On examination you note a dome-shaped retina and subretinal fluid that shifts with position changes. Which of the following is the most likely diagnosis in this patient?
Central retinal vein occlusion
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
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
Acute nongranulomatous anterior uveitis presents with acute unilateral eye pain, redness, photophobia, and vision loss.
Serous retinal detachment
Question 2 Explanation: 
Serous retinal detachment is characterized by a dome shaped retina and subretinal fluid that shifts position with posture changes. Serous retinal detachment results from subretinal fluid accumulation which can occur in exudative age-related macular degeneration.
There are 2 questions to complete.
Shaded items are complete.

References: Merck Manual · UpToDate

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