Retinal Detachment: Types and Risk Factors

• Retinal detachment is a separation of the retina from the underlying epithelium
• It disrupts vision and can cause blindness
• Prompt intervention is needed

Types of Retinal Detachment

• Rhegmatogenous:
  • Most common type
  • A tear or break in the retina allows fluid from the vitreous cavity to seep between the retinal layers
  • Fluid accumulation separates the retina from the retinal pigment epithelium (RPE)
• Tractional:
  • Occurs when pulling forces, usually from scar tissue or membranes on the retina, cause it to detach
  • Often seen in patients with proliferative diabetic retinopathy or other conditions causing retinal neovascularization and subsequent fibrosis
• Exudative (Serous):
  • Results from fluid accumulation beneath the retina due to inflammation, vascular abnormalities, or other conditions
  • No tears or breaks in the retina
  • Fluid comes from the choroid

Risk Factors

• Myopia (nearsightedness): Increased axial length can predispose to retinal tears
• Prior cataract surgery: Can increase the risk of retinal breaks
• Family history: Genetic predisposition
• Age: More common in older adults
• Trauma: Injury to the eye
• Lattice degeneration: Thinning of the peripheral retina
• Diabetic retinopathy: Tractional detachments

Signs and Symptoms

• Flashes of light (photopsia): Often occur with vitreous traction on the retina
• Floaters: Small dark spots or streaks that drift across the field of vision, indicating blood or pigment released into the vitreous
• Blurred vision: Can occur as detachment progresses
• Shadow or curtain in the peripheral vision: Classic symptom as the retina detaches
• Decreased central vision: Occurs if the macula detaches, indicating a more severe detachment

Diagnostic Tests

• Dilated fundus examination: Essential for visualizing the retina
• Slit-lamp biomicroscopy: Provides a magnified view of the retina and vitreous
• Optical coherence tomography (OCT): Scans the retina to evaluate its structure
• Ultrasound: Performed if the view of the retina is obscured by hemorrhage

Treatment Options

• Laser photocoagulation or cryopexy:
  • Used to create chorioretinal adhesion around retinal tears or breaks
  • Prevent fluid from entering and causing detachment
• Pneumatic retinopexy:
  • Involves injecting a gas bubble into the vitreous cavity
  • The bubble flattens the retina against the RPE
  • Laser or cryopexy is then used to seal the tear
• Scleral buckling:
  • A silicone band is sewn onto the sclera to indent the eye wall and relieve traction on the retina
  • May be combined with cryopexy or laser
• Vitrectomy:
  • Surgical removal of the vitreous gel, which then replaces it with a gas or oil
  • Used for complex detachments, tractional detachments, and cases with significant vitreous hemorrhage
  • Often combined with membrane peeling or endolaser

Preoperative Nursing Interventions

• Educate the patient about the surgical procedure
• Explain the expected outcomes, and potential complications
• Obtain informed consent
• Administer prescribed eye drops (e.g., mydriatics, cycloplegics, antibiotics)
• Maintain the patient on NPO status as directed
• Emphasize the importance of following post-operative positioning instructions

Postoperative Nursing Interventions

• Monitor vital signs and assess pain levels
• Administer pain medication as prescribed
• Position the patient as prescribed:
  • Crucial for promoting retinal reattachment, especially with gas or oil tamponade, often face-down
• Educate the patient about activity restrictions
• Avoid strenuous activities, heavy lifting, and sudden head movements
• Administer prescribed eye drops:
  • Antibiotics, anti-inflammatories, and cycloplegics to prevent infection, reduce inflammation, and relieve pain
• Monitor for complications:
  • Increased intraocular pressure (IOP), infection, bleeding, and recurrence of retinal detachment
• Educate the patient on signs and symptoms to report
  • Increased pain, decreased vision, flashes of light, or new floaters
• Provide emotional support:
  • Vision changes can be distressing

Patient Education

• Importance of adherence to prescribed eye drops and medications
• Proper eye hygiene to prevent infection
• Use of eye shields, especially at night, to protect the eye
• Recognizing and reporting potential complications
• Importance of follow-up appointments to monitor progress
• Visual rehabilitation strategies and devices as needed

Potential Complications

• Increased intraocular pressure (IOP): Can lead to glaucoma
• Infection (endophthalmitis): A severe sight-threatening complication
• Bleeding (vitreous hemorrhage): Can obscure vision
• Cataract formation: Can occur after vitrectomy
• Recurrent retinal detachment: Requires further treatment
• Proliferative vitreoretinopathy (PVR): Scar tissue formation on the retina leading to re-detachment