Retinal Detachment Types and Causes

Retinal Detachment (RD)

• Accumulation of subretinal fluid causes separation of neurosensory retina from retinal pigment epithelium (RPE).
• Classified into three main types: rhegmatogenous, tractional, and exudative (serous).

Symptoms of Retinal Detachment

• Sudden onset of multiple floaters.
• Flashes of light in one or both eyes.
• Blurred vision and gradually reduced peripheral vision.
• Curtain-like shadow over the visual field.
• May be asymptomatic at times.

Risk Factors

• Higher prevalence in aging populations, particularly men.
• Extreme myopia increases the risk.
• History of retinal detachment in the fellow eye is a significant risk.
• Family history of RD and previous intraocular surgeries are contributing factors.
• Pre-existing retinal diseases, inflammatory conditions, or severe ocular injuries may predispose individuals.

Types of Retinal Detachment

• Rhegmatogenous RD: Causes include retinal breaks or posterior vitreous detachment (PVD).
• Tractional RD: Characterized by the retina being pulled away by tractional forces, often without tears.
• Exudative/Serous RD: Involves fluid accumulation often without retinal breaks.

Rhegmatogenous Retinal Detachment

• Occurs when vitreous flow behind the retina separates it from the RPE.
• Shafer’s sign (tobacco dust) indicates the presence of retinal pigment cells floating in the vitreous.
• Can result from operculated holes and peripheral horseshoe tears leading to extensive detachment.

Tractional Retinal Detachment

• Occurs due to tangential traction from scar tissue, leading to wrinkling and separation of the retina from the RPE.
• Conditions associated with tractional RD include proliferative diabetic retinopathy and other vascular and inflammatory disorders.

Exudative/Serous Retinal Detachment

• Fluid accumulation can arise from retinal or choroidal vascular sources.
• Causes include idiopathic origins, inflammatory conditions, infections, neoplastic issues, and vascular disorders.
• Notable conditions include Coats disease, VKH syndrome, and central serous chorioretinopathy.

Long-standing Retinal Detachment Features

• May show a pigmented demarcation line and subretinal fibrosis.
• Development of intraretinal cysts and neovascularization in the peripheral retina may occur.

Management of Retinal Detachment

• Treatment options include laser retinopexy, cryopexy, scleral buckle, pneumatic retinopexy, and pars plana vitrectomy.
• Surgical intervention has a high anatomical success rate, but visual outcomes can vary significantly depending on the timing and condition of the macula.

Retinoschisis vs. Retinal Detachment

• Retinoschisis involves separation within the neurosensory retina, leading to an absolute scotoma and a transparent dome-shaped appearance.
• Retinal detachment features separation from the RPE, relative scotoma, opaque appearance, and an undulating surface that changes shape during indentation.

Choroidal Detachment

• Can present as a smooth, bullous elevation of the retina, potentially extending 360 degrees.
• Types include serous and hemorrhagic, with serous detachment associated with conditions like hypotony, inflammation, and malignancies.

Management of Choroidal Detachment

• Conservative management focuses on underlying causes and may require medications like steroids.
• Surgical drainage may be necessary for persistent effusion leading to decreased vision or flat anterior chamber.

Uveal Effusion Syndrome

• Affects primarily middle-aged men, causing painless vision loss and significant choroidal elevation with normal intraocular pressure.
• Associated with high hyperopia and can result from impaired scleral permeability.

Hemorrhagic Choroidal Detachment

• Characterized by abrupt onset and severe pain, often linked to surgical complications, trauma, or spontaneous cases.
• High intraocular pressure (IOP) can occur, necessitating careful management.