eMedicine Specialties > Ophthalmology > Retina

Retinal Detachment, Rhegmatogenous: Differential Diagnoses & Workup

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

Differential Diagnoses

Acute Retinal Necrosis
Retinitis, CMV
Retinal Detachment, Exudative
Retinoschisis, Senile
Retinal Detachment, Postoperative
Retinal Detachment, Proliferative
Retinal Detachment, Tractional

Workup

Imaging Studies

  • Ultrasound
    • On certain occasions, the media may not be clear, impairing a thorough retinal examination with the binocular indirect ophthalmoscope. An ultrasound is a useful adjunct in these situations.
    • Ultra–high-frequency sounds travel to the back of the eye as the probe emits them. Once a structure is contacted by the sound waves, the sound wave is attenuated and reflected back to the probe. The pattern of these waves is specific for certain tissues. Thus, localization and tissue characterization is possible using this technique. Typically, an A scan and a B scan are obtained. For instance, retinal tissue usually shows a large spike in the A scan, reflecting an increased acoustic density of the tissue. The B scan shows a composite picture of the globe and its intraocular contents.
    • Sometimes, it may be difficult to differentiate a retinal detachment from a thickened, partially detached posterior hyaloid. In this case, A-scan and B-scan findings often overlap. Tissue mobility during scanning may help to differentiate the two. Usually, a RRD has a characteristic undulating motion after a sudden saccade, whereas a thickened posterior hyaloid moves in a brisker manner but with less excursion.
  • Fluorescein angiography (FA): Cystoid macular edema may complicate the postoperative course of an eye that has undergone retinal reattachment surgery. FA is a useful adjunct in helping to diagnose this condition.
  • Optical coherence tomography (OCT): Occasionally, certain eyes appear to have complete retinal reattachment, but the visual acuity appears to be incomplete or delayed. OCT helps to reveal subfoveal fluid in these eyes.

Other Tests

  • Electroretinogram (ERG): When a patient presents with a dense vitreous hemorrhage or a cataract that precludes direct visualization of the retina, an ultrasound of the posterior pole is indicated. Sometimes, differentiating a RRD and a thickened posterior hyaloid that is partially detached using ultrasound is difficult. In these circumstances, an ERG is a useful adjunct in the evaluation of a patient suspected of having a RRD. If a good response from the ERG is obtained, the retina is probably attached. If the electric response from the retina is attenuated to a great degree, the retina is probably detached.

Histologic Findings

During separation of the neurosensory retina from the RPE, the choroidal blood flow to the outer retinal layers is lost. The RPE also loses its ability to modulate the health of the outer segments of the photoreceptors. Initially, the outer segments of the photoreceptors are lost. After successful retinal reattachment, the outer segments may regenerate. As the detachment becomes more chronic, atrophy of the entire photoreceptor layer, cystic degeneration, macrocyst formation, demarcation lines, and even rubeosis iridis may be seen.

More on Retinal Detachment, Rhegmatogenous

Overview: Retinal Detachment, Rhegmatogenous
Differential Diagnoses & Workup: Retinal Detachment, Rhegmatogenous
Treatment & Medication: Retinal Detachment, Rhegmatogenous
Follow-up: Retinal Detachment, Rhegmatogenous
Multimedia: Retinal Detachment, Rhegmatogenous
References
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Further Reading

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Keywords

rhegmatogenous retinal detachment, RRD, subretinal fluid accumulation, retinal tear, neurosensory retina, retinal pigment epithelium, RPE, vitreoretinal traction, posterior vitreous detachment, PVD, vitreoretinal adhesions

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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, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest 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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