eMedicine Specialties > Ophthalmology > Retina

Retinal Detachment, Exudative

Author: Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Coauthor(s): Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Contributor Information and Disclosures

Updated: Aug 2, 2007

Introduction

Background

Anytime subretinal fluid accumulates in the space between the neurosensory retina and the underlying retinal pigment epithelium (RPE), a retinal detachment occurs. Depending on the mechanism of subretinal fluid accumulation, retinal detachments traditionally have been classified into rhegmatogenous, tractional, and exudative.

Pathophysiology

Under normal conditions, water flows from the vitreous cavity to the choroid. The direction of flow is influenced by the relative hyperosmolarity of the choroid with respect to the vitreous and the RPE that actively pumps ions and water from the vitreous into the choroid. When there is an increase in the inflow of fluid or a decrease in the outflow of fluid from the vitreous cavity that overwhelms the normal compensatory mechanisms, fluid accumulates in the subretinal space leading to an exudative retinal detachment. For instance, certain pathological conditions are characterized by the presence of abnormal blood vessels that leak profusely. Other conditions are characterized by a broken blood-retinal barrier. All these conditions increase the inflow of fluid into the vitreous cavity. On the other hand, abnormally thick sclera, as seen in nanophthalmos, decreases the outflow of fluid. Damage to the RPE prevents the pumping action of fluid.

Frequency

United States

Given the diverse nature of the underlying causes of exudative retinal detachments, no reports are available on the frequency of this condition.

Mortality/Morbidity

Mortality and morbidity depend on the underlying cause. For instance, a patient with an exudative retinal detachment from scleritis secondary to rheumatoid arthritis has a severe condition. Compare this to a healthy patient who underwent scleral buckling surgery with an exudative retinal detachment. The outlooks are very different in each case.

Race

Racial predilection depends on the underlying cause, to include the following:

  • Vogt-Koyanagi-Harada syndrome appears to be more common in Asians and Hispanics than in Caucasians.
  • Choroidal melanoma is more common in Caucasians than in other races.
  • Exudative age-related macular degeneration is more common in Caucasians than in other races.

Sex

Sex predilection depends on the underlying cause, to include the following:

  • Coats disease is more common in males than in females.
  • The uveal effusion syndrome is more common in males than in females.
  • Idiopathic central serous chorioretinopathy occurs more commonly in men than in women.

Age

Age predilection depends on the underlying cause, to include the following:

  • Coats disease is more common in children and young adults.
  • Exudative age-related macular degeneration is a condition of elderly persons.
  • Idiopathic central serous retinopathy occurs most often in middle-aged people.

Clinical

History

  • Patients may complain of a red eye (eg, uveitic pathologies).
  • Patients may notice a decrease in vision or visual field defect.
  • Pain may be present (eg, scleritis).
  • Parents may notice a white pupil (leukocoria).

Physical

  • Bullous retinal detachment with shifting subretinal fluid: Depending on the position of the patient, the fluid accumulates in its most dependent position.
  • The retina is characterized by a smooth surface that lacks folds as seen in a rhegmatogenous retinal detachment (RRD).
  • The anterior segment may show signs of inflammation (eg, episcleral injection, iridocyclitis) or even rubeosis depending on the underlying cause.
  • In chronic cases, deposition of hard exudates may be seen.
  • Dilated telangiectatic vessels may be seen.

Causes

An extensive list of conditions that cause exudative retinal detachments exists. The conditions have been classified according to similar pathogenic mechanisms.

  • Idiopathic
    • Coats disease
    • Central serous chorioretinopathy
    • Uveal effusion syndrome
  • Inflammatory
    • Vogt-Koyanagi-Harada syndrome
    • Syphilis
    • Scleritis
    • Sympathetic ophthalmia
    • Other vasculitic entities (eg, rheumatoid arthritis, Wegener granulomatosis)
    • Other uveitic conditions (eg, toxoplasmosis, cytomegalovirus [CMV] retinitis)
    • Dengue fever
    • Orbital pseudotumor
    • Lymphomatoid granulomatosis
  • Congenital
    • Nanophthalmos
    • Colobomas of the optic nerve
    • Familial exudative vitreoretinopathy
  • Neoplastic
    • Choroidal melanoma
    • Choroidal metastases
    • Choroidal nevus
    • Choroidal hemangioma
    • Retinoblastoma
    • Primary intraocular lymphoma
  • Iatrogenic
    • Excessive panphotocoagulation
    • Scleral buckling
  • Vascular factors
    • Eclampsia
    • Exudative age-related macular degeneration
    • Chronic renal failure
    • Hypertension

More on Retinal Detachment, Exudative

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Treatment & Medication: Retinal Detachment, Exudative
Follow-up: Retinal Detachment, Exudative
Multimedia: Retinal Detachment, Exudative
References
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References

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Further Reading

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Keywords

exudative retinal detachment, serous retinal detachment, nonrhegmatogenous retinal detachment, subretinal fluid accumulation, neurosensory retina, retinal pigment epithelium, RPE, retinal breaks, retinal tears

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Contributor Information and Disclosures

Author

Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Disclosure: Nothing to disclose.

Medical Editor

Vytautas A Pakainis, MD, Chief of Ophthalmology, Dorn Veterans Administration Medical Center, Professor of Ophthalmology, Ophthalmology, University of South Carolina School of Medicine
Vytautas A Pakainis, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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