eMedicine Specialties > Emergency Medicine > Ophthalmology

Retinal Detachment: Differential Diagnoses & Workup

Author: Gregory L Larkin, MD, MS, MSPH, FACEP, Professor of Surgery, Associate Director of Emergency Medicine, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Nov 23, 2009

Differential Diagnoses

Retinal Artery Occlusion

Other Problems to Be Considered

Rhegmatogenous retinal detachment

Posterior vitreous detachment
Peripheral retinal lesions (eg, enclosed oral bays, meridional folds, cystic retinal tufts, lattice degeneration)
Myopia
Senile retinoschisis
Cataract extraction
Trauma
Intraocular inflammation/infection

  • Acute retinal necrosis syndrome
  • Cytomegalovirus retinitis
  • Ocular toxocariasis
  • Ocular toxoplasmosis
  • Pars planitis

Colobomas of the choroid and retina
Coloboma of the lens (giant retinal tear)
Stickler syndrome
Goldmann-Favre syndrome
Marfan syndrome
Homocystinuria
Ehlers-Danlos syndrome

Tractional retinal detachment

Proliferative diabetic retinopathy
Sickle cell (SC) disease (hemoglobin SC, hemoglobin S-thalassemia)
Familial exudative vitreoretinopathy
Retinopathy of prematurity
Penetrating trauma with vitreous bands
Cataract surgery with vitreous loss

Exudative retinal detachment

Primary tumors (eg, malignant melanoma of the choroid, hemangioma of the choroid, retinoblastoma)
Metastatic carcinoma to the choroid (eg, breast cancer, lung cancer)
Inflammation (eg, choroiditis [Harada disease], retinitis [toxoplasmosis, CMV])
Vascular disease

  • Angiomatosis of the retina (ie, Von Hippel disease)
  • Telangiectasia retina
  • Juvenile Coat disease
  • Adult Coat disease
  • Eales disease
  • Retinal vein occlusion

Optic nerve disease
  • Pit of the optic disc with serous detachment of the macula
  • Nerve head drusen with serosanguineous detachment of adjacent retina
  • Leber Stellate maculopathy

Macular disease
  • Central serous chorioretinopathy
  • Age-related macular degeneration
  • Other causes of disciform detachment
  • Ocular histoplasmosis
  • Angioid streaks, high myopia (>6 diopters)

Systemic diseases (eg, toxemia, uremia, systemic lupus erythematosus [SLE], leukemia)

Lesions that may simulate retinal detachment

Cerebrovascular accident or transient ischemic attack
Optic neuritis
Atypical migraine
Vitreous (eg, membranes, hemorrhages, inflammation)
Posterior vitreous detachment
Retinal

  • Primary retinoschisis
  • Juvenile
  • Degenerative
  • Secondary retinoschisis
  • Retinopathy of prematurity
  • Diabetic retinopathy
  • Retinal artery occlusion (mainly branch retinal artery occlusion)

Choroidal detachment (eg, serous, hemorrhagic)

Workup

Laboratory Studies

  • Laboratory tests are generally unhelpful in detecting retinal detachment, but they may be useful for patients who have underlying medical problems that need to be managed. Subsequent testing may be necessary to detect underlying causes or related illnesses.

Imaging Studies

  • Imaging techniques, such as orbital films, CT scans, or MRIs, are not necessary or indicated to assist the diagnoses retinal detachment, but they may be necessary to detect intraocular foreign bodies and tumors.
  • A prospective observational study on use of ultrasound scans by ED physicians in patients with signs of retinal detachment showed a 97% sensitivity (95% confidence interval [CI], 82-100%) and 92% specificity (95% CI, 82-97%) on 92 examinations (29 retinal detachments).3
  • If the retina cannot be visualized because of corneal changes, cataracts, or hemorrhage, ultrasonography is necessary.
    • A scan ultrasound and B scan ultrasound both can assist the diagnoses of RD and differentiate it from posterior vitreous detachment. They also can differentiate rhegmatogenous from nonrhegmatogenous detachment.
    • In exudative detachments, the presence of underlying subretinal tumors, choroidal hemorrhage, or detachment can be detected by ultrasound.

More on Retinal Detachment

Overview: Retinal Detachment
Differential Diagnoses & Workup: Retinal Detachment
Treatment & Medication: Retinal Detachment
Follow-up: Retinal Detachment
Multimedia: Retinal Detachment
References
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References

  1. Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol. Feb 1982;100(2):289-92. [Medline].

  2. Subramanian ML, Topping TM. Controversies in the management of primary retinal detachments. Int Ophthalmol Clin. 2004;44(4):103-14. [Medline].

  3. Shinar Z, Chan L, Orlinsky M. Use of Ocular Ultrasound for the Evaluation of Retinal Detachment. J Emerg Med. Jul 20 2009;[Medline].

  4. Blaivas M, Theodoro D, Sierzenski PR. A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med. Aug 2002;9(8):791-9. [Medline].

  5. Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine. 3rd ed. WB Saunders; 1998.

  6. Rosen P, Baker FJ, Barkin RM. Emergency Medicine: Concepts and Clinical Practice. Vol 1. Mosby-Year Book; 1988:1033-49.

  7. Rosen P, Barkin RM, Sternbach GL. Essentials of Emergency Medicine. Mosby-Year Book; 1991:553-66.

  8. Tintinalli JE, Krome RL, Ruiz E. Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill; 1992:833-40.

  9. Wilkes SR, Beard CM, Kurland LT, et al. The incidence of retinal detachment in Rochester, Minnesota, 1970-1978. Am J Ophthalmol. Nov 1982;94(5):670-3. [Medline].

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Further Reading

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Keywords

retinal detachment, retinal detachment symptoms, retinal detachment diagnosis, retinal detachment treatment, RD, critical eye emergency, rhegmatogenous retinal detachment, exudative retinal detachment, serous retinal detachment, tractional retinal detachment, proliferative diabetic retinopathy, ocular trauma, traumatic detachments, posterior vitreous detachment, vitreous hemorrhage

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Contributor Information and Disclosures

Author

Gregory L Larkin, MD, MS, MSPH, FACEP, Professor of Surgery, Associate Director of Emergency Medicine, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine
Gregory L Larkin, MD, MS, MSPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Society for Bioethics and Humanities, Association for the Advancement of Automotive Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Joseph A Salomone III, MD, EMS Medical Director, Kansas City, Missouri; Associate Professor and Staff Physician, Truman Medical Centers/UMKC School of Medicine
Joseph A Salomone III, MD is a member of the following medical societies: American Academy of Emergency Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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