Retinal detachment: The Daily PANCE Blueprint
A 59-year-old male complains of "flashing lights behind my eye" followed by a 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 the fundoscopic exam, the retina appears to be out of focus. Which of the following is the most likely diagnosis?
A. Central retinal vein occlusion
B. Retinal artery occlusion
C. Retinal detachment
D. Hyphema
Answer and topic summary
The answer is C: Retinal Detachment
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.
- Central retinal vein and artery occlusion cause painless, variable loss of vision. Exam shows retinal hemorrhages in all quadrants and edema of the optic disk
- Hyphema is usually associated with trauma and is a collection of blood in the anterior chamber
View blueprint lesson
Retinal Detachment Pearls
- Retinal detachment is a separation of the neurosensory retina from the underlying retinal pigment epithelium
- Look for sudden increase or change in floaters along with curtain or veil across the visual field
- Often is spontaneous, but may have an underlying cause – example recent cataract surgery
- Myopia (nearsightedness) is a risk factor for the development of retinal detachment
- Retinal detachment is usually unilateral
- Retinal detachment usually presents with defects in the peripheral visual field
Diagnosis
- Diagnosis is by fundoscopy – retinal detachment is visualized as 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
Treatment
- 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
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