eMedicine Specialties > Emergency Medicine > Ophthalmology

Retinal Detachment: Treatment & Medication

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

Treatment

Prehospital Care

Protecting the globe in cases of traumatic retinal detachment may be important to prevent extrusion of intraocular contents (ie, uveal tissue), and can be achieved with goggles or a metallic eye shield, if available. It is imperative to avoid pressure on the globe.

Emergency Department Care

ED treatment of retinal detachment consists of evaluating the patient and treating any unstable vital signs, preparing the patient for possible emergency surgery.

  • The repair technique is dependent on the type, location, and size of the detachment.
    • Laser therapy and cryotherapy are ambulatory outpatient procedures.
    • Use of intraocular gas (ie, pneumatic retinopexy) to tamponade the detachment can be an outpatient procedure with close follow-up of the intraocular pressure.
    • Scleral buckling, in which a silicone band indents the eye to approximate the retina and RPE, is possible as an outpatient procedure. The tear is closed with supplemental cryotherapy or laser.
    • Intraocular repair with pars plana vitrectomy may be necessary in complicated tractional and exudative detachments. This procedure once required hospitalization but is now being performed on an outpatient or short-stay basis because of insurance restrictions.
    • Inflammatory retinal detachments (RDs) usually are treated medically.
    • An important study in 25 European centers comparing scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment (SPR Study) may answer questions as to the better therapy.

Consultations

  • When diagnosed or highly suspected, retinal detachment (RD) requires an emergent ophthalmologic consultation for confirmation and treatment. This is particularly true for RDs that threaten the fovea or central vision.
  • Ideally, patients with RD should be referred to a retinal-vitreous specialist as soon as they are suspected. However, immediate retinal-vitreous specialist consultation is not necessary in all cases because many general ophthalmologists are capable of performing indirect ophthalmoscopy and determining the need for further intervention.
  • Frequently, time is critical; however, the time frame is hours and not minutes, and many cases do not require emergency surgery. Inflammatory retinal detachments, for example, usually are treated medically. Acute retinal breaks should be surgically repaired within 24 hours if at all possible.

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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