Exudative Retinal Detachment Clinical Presentation

Updated: Mar 11, 2016
  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

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).

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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.

The images below show exudative retinal detachment in a patient with Coats disease.

An 8-year-old boy with Coats disease. Notice the m An 8-year-old boy with Coats disease. Notice the macular exudation.
An 8-year-old boy with Coats disease. Notice the p An 8-year-old boy with Coats disease. Notice the peripheral vascular dilatations. This patient underwent cryotherapy months before, and the exudative retinal detachment has basically disappeared.
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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

  • Infectious

    • Syphilis

    • Toxoplasmosis

    • Cytomegalovirus [CMV] retinitis

    • Dengue fever

    • Tuberculosis

    • Lyme disease

    • Catscratch disease

  • Congenital

    • Nanophthalmos

    • Colobomas of the optic nerve

    • Familial exudative vitreoretinopathy

  • Neoplastic

  • Renal diseases

    • Lupus nephritis

    • Crescentic membranous nephropathy

    • Goodpasture syndrome

    • Patients on hemodialysis

    • IgA nephropathy

    • Type II membrane proliferative glomerulonephritis

    • Chronic renal failure

  • Iatrogenic

    • Excessive panphotocoagulation

    • Scleral buckling

  • Systemic disorders that induce an occlusive vascular choroidal disorder

    • Pregnancy-induced hypertension (eclampsia/preeclampsia)

    • Malignant hypertension

    • Collagen vascular diseases

    • Disseminated intravascular coagulopathy

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