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Rhegmatogenous Retinal Detachment Clinical Presentation

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Sep 29, 2015
 

History

Specifically ask patients about risk factors that predispose to premature PVD.

  • Myopia
  • Prior intraocular surgery
  • Family history
  • RRD in the fellow eye

Photopsias

Photopsias refer to the perception of flashing lights by the patient. It probably arises from the mechanical stimulation of vitreoretinal traction on the retina. It may be induced by eye movements and appears to be more noticeable in dim illumination.

Visual field defect

Patients often describe a black curtain (visual field defect) once the subretinal fluid extends posterior to the equator.

Floaters

Floaters are opacities in the vitreous that cast a dark shadow according to their form and shape in the patient's visual field as they float in the vitreous cavity.

A ring-shaped floater is the Weiss ring or the remnant of the hyaloid that was attached to the edges of the optic disc.

Cobwebs are caused by condensation of the collagen fibers.

Small spots usually indicate fresh blood due to the rupture of a retinal vessel during an acute PVD.

Loss of central vision

When the macula becomes detached (ie, extension of subretinal fluid into the macula), the patient experiences a drop in visual acuity.

In other cases, a large bullous detachment may obstruct the macula, causing decreased visual acuity despite the fact that the macula is not detached.

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Physical

Cell and flare may be seen in the anterior chamber of eyes with a rhegmatogenous retinal detachment (RRD).

The intraocular pressure is usually lower in the eye with a RRD than in the fellow eye; this is usually reversed by retinal reattachment. In certain cases, the intraocular pressure may be higher than in the fellow eye.

Pigment in the anterior vitreous (tobacco dusting or a Shaffer sign) is usually present.

Once the retina becomes detached, it assumes a slightly opaque color secondary to intraretinal edema. It has a convex configuration, has a corrugated appearance, and undulates freely with eye movements unless severe proliferative vitreoretinopathy (PVR) is present.

A retinal break in the shape of a horseshoe or flap is often present. Of all RRDs, 50% have more than 1 break. Of all breaks, 60% are located in the upper temporal quadrant, and 15% are located in the upper nasal quadrant. Another 15% are in the lower temporal quadrant, and 10% are in the lower nasal quadrant.

Chronic RRD may present with retinal thinning, intraretinal cysts, subretinal fibrosis, and demarcation lines. These lines are usually at the junction of attached and detached retina. Even though they represent areas of increased retinal adhesion to the RPE, it is not uncommon for subretinal fluid to spread beyond the lines.

Rhegmatogenous retinal detachment is shown in the images below.

Clinical picture of a rhegmatogenous retinal detacClinical picture of a rhegmatogenous retinal detachment involving the macula. Notice the folds just temporal to the fovea.
Clinical picture of a rhegmatogenous retinal detacClinical picture of a rhegmatogenous retinal detachment. Notice that the macula is involved and that the retina is corrugated and has a slightly opaque color.
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Causes

The main cause of a rhegmatogenous retinal detachment (RRD) is a PVD that leads to retinal tear formation. The following are risk factors that commonly share the premature liquefaction of the vitreous gel leading to an increased rate of PVD.

Abnormal vitreoretinal adhesions, which may be visible or invisible, are present in many eyes. Among the visible ones are enclosed oral bays, lattice degeneration, and cystic retinal tufts. When a PVD occurs and encounters such an area, a retinal tear may form.

Prior intraocular surgery, especially cataract extraction: It appears that an intact posterior capsule delays the onset of PVD. Other procedures, such as penetrating keratoplasty and pars plana vitrectomy (PPV), also may be complicated by a RRD.

Certain familial conditions, such as Stickler syndrome, Marfan syndrome, homocystinuria, and Ehlers-Danlos syndrome, are associated with RRD.

Inflammatory or infectious conditions, such as acute retinal necrosis syndrome, CMV retinitis in AIDS patients, ocular toxoplasmosis, and pars planitis

Axial myopia may be noted.

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Contributor Information and Disclosures
Author

Lihteh Wu, MD Asociados de Macula Vitreo y Retina de 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, Club Jules Gonin, Macula Society, Pan-American Association of Ophthalmology, Retina Society

Disclosure: Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical; Heidelberg Engineering.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

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, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Teodoro Evans, MD Consulting Surgeon, Vitreo-Retinal Section, Clinica de Ojos, Costa Rica

Disclosure: Nothing to disclose.

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Clinical picture of a rhegmatogenous retinal detachment involving the macula. Notice the folds just temporal to the fovea.
Clinical picture of a rhegmatogenous retinal detachment. Notice that the macula is involved and that the retina is corrugated and has a slightly opaque color.
This patient had a vitreous hemorrhage that prevented visualization of the retina. A B-scan ultrasound reveals a retinal detachment.
 
 
 
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