Diferencia entre revisiones de «Retinal detachment»
(Major expansion: types, risk factors, POCUS evaluation, disposition guidance, references) |
(Strip excess bold) |
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| Línea 3: | Línea 3: | ||
*'''Ophthalmologic emergency''' — requires urgent referral; macula-off detachments should be repaired within 24-72 hours | *'''Ophthalmologic emergency''' — requires urgent referral; macula-off detachments should be repaired within 24-72 hours | ||
*Three types: | *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> | *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> | ||
| Línea 18: | Línea 18: | ||
==Clinical Features== | ==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) | *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== | ||
| Línea 35: | Línea 35: | ||
==Evaluation== | ==Evaluation== | ||
* | *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> | ||
**Undulating membrane tethered to the optic disc (distinguishes from posterior vitreous detachment) | **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 | **May be difficult to visualize in ED without pupil dilation | ||
* | *Visual acuity — document in all patients | ||
* | *Pupil exam — [[Relative afferent pupillary defect|APD]] may be present | ||
==Management== | ==Management== | ||
* | *Emergent ophthalmology consultation | ||
**Macula-on detachment: repair within 24 hours (to preserve central vision) | **Macula-on detachment: repair within 24 hours (to preserve central vision) | ||
**Macula-off detachment: repair within 24-72 hours; outcomes less time-sensitive | **Macula-off detachment: repair within 24-72 hours; outcomes less time-sensitive | ||
| Línea 49: | Línea 49: | ||
*If a superior detachment, position patient upright (to slow progression) | *If a superior detachment, position patient upright (to slow progression) | ||
*If inferior detachment, supine positioning | *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 | *Surgical options (for ophthalmology): pneumatic retinopexy, scleral buckle, vitrectomy | ||
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
- Posterior vitreous detachment (most common cause of flashes/floaters; benign)
- Vitreous hemorrhage
- Central retinal artery occlusion
- Central retinal vein occlusion
- Optic neuritis
- Migraine with visual aura
- Acute angle-closure glaucoma
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
- Posterior vitreous detachment
- Vitreous hemorrhage
- Central retinal artery occlusion
- Acute angle-closure glaucoma
- Eye emergencies
References
- ↑ Haimann MH, et al. Epidemiology of retinal detachment. Arch Ophthalmol. 1982;100(2):289-292. PMID 7065948.
- ↑ 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.