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==Background==
==Background==
[[File:A Retinal Detachment.jpg|thumb|Retinal detachement]]
*Separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE)
[[File:Ocular - Retinal detachment.gif|thumb]]
*'''Ophthalmologic emergency''' — requires urgent referral; macula-off detachments should be repaired within 24-72 hours
*Average age of onset ~55
*Three types:
**Rhegmatogenous (most common) — tear/break allows vitreous fluid under retina
**Tractional — fibrous bands pull retina (diabetic retinopathy, sickle cell)
**Exudative — fluid accumulation without a break (inflammation, tumor)
*Annual incidence: ~1 in 10,000<ref name="haimann">Haimann MH, et al. Epidemiology of retinal detachment. ''Arch Ophthalmol''. 1982;100(2):289-292. PMID 7065948.</ref>


===Types===
==Risk Factors==
#Rhegmatogenous (rhegma means "tear")
*Myopia (nearsightedness) — strongest risk factor
#*As vitreous separates from retina the traction creates a hole in retina
*Prior cataract surgery
#**Fluid goes through the hole and peels the retina off like wallpaper
*Trauma (blunt or penetrating)
#Exudative
#*Fluid accumulates beneath the retina without a retinal tear
#*Associated with neoplasm, inflammatory conditions, hypertension, preeclampsia
#Tractional
#*Acquired fibrocellular bands in the vitrous contract and detach the retina
#*Associated with DM, sickle cell, trauma
#Distinguish between mac-off and mac-on
 
===Other risk factors===
*Aging
*Previous retinal detachment
*Family history of retinal detachment
*Family history of retinal detachment
*Extreme myopia
*Prior retinal detachment in fellow eye
*Eye surgery, cataract removals
*Lattice degeneration
*Age >50 (posterior vitreous detachment)


==Clinical Features==
==Clinical Features==
*Abrupt onset of new [[Acute onset flashers and floaters|"floaters" or flashes of light]]
*Painless visual symptoms (pain suggests alternative diagnosis)
**Vitreous tugs on the retina before separation
*Photopsia — flashing lights (traction on retina)
*Visual acuity loss (filmy, cloudy, or curtain-like) or visual field loss
*Floaters — sudden onset or dramatic increase
**May be mild or dramatic
*Visual field deficit — described as a "curtain" or "shadow" moving across vision
*Decreased visual acuity if macula involved (macula-off detachment)
*Shafer sign (tobacco dust / pigment in anterior vitreous) is pathognomonic on slit lamp
 
==Differential Diagnosis==
==Differential Diagnosis==
{{Acute vision loss noninflamed DDX}}
*[[Posterior vitreous detachment]] (most common cause of flashes/floaters; benign)
 
*[[Vitreous hemorrhage]]
{{Acute onset flashers and floaters DDX}}
*[[Central retinal artery occlusion]]
*[[Central retinal vein occlusion]]
*[[Optic neuritis]]
*[[Migraine]] with visual aura
*[[Acute angle-closure glaucoma]]


==Evaluation==
==Evaluation==
[[File:RetinalDetachment.jpeg|thumbnail]]
*Bedside ocular ultrasound — high sensitivity (97%) for detecting retinal detachment<ref name="blaivas">Blaivas M, et al. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. ''Acad Emerg Med''. 2005;12(9):844-849. PMID 16141018.</ref>
*Examination
**Undulating membrane tethered to the optic disc (distinguishes from posterior vitreous detachment)
**Visual acuity and visual fields
*Fundoscopic exam: retinal elevation, tears, or folds
**Fundoscopic exam with dilation
**May be difficult to visualize in ED without pupil dilation
*Ocular ultrasound
*Visual acuity — document in all patients
**Generally remains anchored to the optic disc in most posterior section of the eye
*Pupil exam — [[Relative afferent pupillary defect|APD]] may be present
**Appears as a hyperechoic membrane floating in the vitreous chamber


==Management==
==Management==
*Position patient relative to area of retinal detachment so retina lies flat:
*Emergent ophthalmology consultation
**Superior detachment = lay patient's head in supine position
**Macula-on detachment: repair within 24 hours (to preserve central vision)
**Inferior detachment = elevate head up
**Macula-off detachment: repair within 24-72 hours; outcomes less time-sensitive
**Different from face-down recovery position after pneumatic retinopexy (so that bubble covers retinal break)
*Restrict activity and avoid Valsalva maneuvers
**May know where retinal detachment is by a couple of clues:
*If a superior detachment, position patient upright (to slow progression)
***Good fundoscopy
*If inferior detachment, supine positioning
***US beam orientation
*No specific ED treatment will reverse detachment — definitive repair is surgical
***[[Visual Field Defects]] examples<ref>Gariano RF and Kim CH. Evaluation and Management of Suspected Retinal Detachment. Am Fam Physician. 2004 Apr 1;69(7):1691-1699.</ref>:
*Surgical options (for ophthalmology): pneumatic retinopexy, scleral buckle, vitrectomy
****Superior detachment may have inferior visual field defect
****Temporal detachment may have nasal visual field defect


==Disposition==
==Disposition==
*Urgent ophtho referral within 24hr (pneumatic retinopexy, scleral buckle, or vitrectomy)<ref>Illinois Retina and Eye Associates. Retinal Detachment. 2009. http://www.illinoisretinainstitute.com/index.php?p=1_11.</ref>
*Emergent ophthalmology referral for all suspected retinal detachments
**In macular off retinal detachment, visual acute is significantly decreased if reattachment does not occur within 6 days. <ref>Diederen R et al: Scleral buckling surgery after macula-off retinal detachment: Worse visual outcome after more than 6 days. Ophthalmology 2007; 114:705-709</ref>
*Macula-on: same-day evaluation and likely same-day repair
*Macula-off: urgent repair within days; outpatient if ophthalmology comfortable
*Posterior vitreous detachment without retinal break: outpatient ophthalmology follow-up within 1-2 weeks


==See Also==
==See Also==
*[[Acute Onset Flashers and Floaters]]
*[[Posterior vitreous detachment]]
*[[Ocular ultrasound]]
*[[Vitreous hemorrhage]]
*[[Central retinal artery occlusion]]
*[[Acute angle-closure glaucoma]]
*[[Eye emergencies]]


==References==
==References==

Revisión actual - 09:36 22 mar 2026

Background

  • Separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE)
  • Ophthalmologic emergency — requires urgent referral; macula-off detachments should be repaired within 24-72 hours
  • Three types:
    • Rhegmatogenous (most common) — tear/break allows vitreous fluid under retina
    • Tractional — fibrous bands pull retina (diabetic retinopathy, sickle cell)
    • Exudative — fluid accumulation without a break (inflammation, tumor)
  • Annual incidence: ~1 in 10,000[1]

Risk Factors

  • Myopia (nearsightedness) — strongest risk factor
  • Prior cataract surgery
  • Trauma (blunt or penetrating)
  • Family history of retinal detachment
  • Prior retinal detachment in fellow eye
  • Lattice degeneration
  • Age >50 (posterior vitreous detachment)

Clinical Features

  • Painless visual symptoms (pain suggests alternative diagnosis)
  • Photopsia — flashing lights (traction on retina)
  • Floaters — sudden onset or dramatic increase
  • Visual field deficit — described as a "curtain" or "shadow" moving across vision
  • Decreased visual acuity if macula involved (macula-off detachment)
  • Shafer sign (tobacco dust / pigment in anterior vitreous) is pathognomonic on slit lamp

Differential Diagnosis

Evaluation

  • Bedside ocular ultrasound — high sensitivity (97%) for detecting retinal detachment[2]
    • Undulating membrane tethered to the optic disc (distinguishes from posterior vitreous detachment)
  • Fundoscopic exam: retinal elevation, tears, or folds
    • May be difficult to visualize in ED without pupil dilation
  • Visual acuity — document in all patients
  • Pupil exam — APD may be present

Management

  • Emergent ophthalmology consultation
    • Macula-on detachment: repair within 24 hours (to preserve central vision)
    • Macula-off detachment: repair within 24-72 hours; outcomes less time-sensitive
  • Restrict activity and avoid Valsalva maneuvers
  • If a superior detachment, position patient upright (to slow progression)
  • If inferior detachment, supine positioning
  • No specific ED treatment will reverse detachment — definitive repair is surgical
  • Surgical options (for ophthalmology): pneumatic retinopexy, scleral buckle, vitrectomy

Disposition

  • Emergent ophthalmology referral for all suspected retinal detachments
  • Macula-on: same-day evaluation and likely same-day repair
  • Macula-off: urgent repair within days; outpatient if ophthalmology comfortable
  • Posterior vitreous detachment without retinal break: outpatient ophthalmology follow-up within 1-2 weeks

See Also

References

  1. ↑ Haimann MH, et al. Epidemiology of retinal detachment. Arch Ophthalmol. 1982;100(2):289-292. PMID 7065948.
  2. ↑ Blaivas M, et al. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-849. PMID 16141018.
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