Exudative Retinal Detachment Clinical Presentation

Updated: Aug 10, 2021
  • Author: Lihteh Wu, MD; Chief Editor: Inci Irak Dersu, MD, MPH  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 a 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 

Idiopathic causes are as follows:

  • Coats disease

  • Central serous chorioretinopathy

  • Uveal effusion syndrome

Inflammatory

A 2020 multicenter retrospective study from the United States found that 1.2% (176/14,612) of eyes with ocular inflammation seen from 1978-2007 presented with an exudative retinal detachment. The most common causes included Vogt-Koyanagi-Harada syndrome, undifferentiated choroiditis, sympathetic ophthalmia, primary or secondary panuveitis, multifocal choroiditis with panuveitis, and other causes of posterior uveitis. [2]

Inflammatory causes are as follows:

Infectious

Infectious causes are as follows:

  • Syphilis

  • Cytomegalovirus [CMV] retinitis

  • Dengue fever

  • Tuberculosis [3]

  • Lyme disease

  • Catscratch disease

Congenital

Congenital causes are as follows:

  • Nanophthalmos

  • Colobomas of the optic nerve

  • Familial exudative vitreoretinopathy

Tumors

The following tumors may result in exudative retinal detachment:

Renal diseases

The following renal disease may result in exudative retinal detachment:

  • Lupus nephritis

  • Crescentic membranous nephropathy

  • Goodpasture syndrome

  • Patients on hemodialysis

  • IgA nephropathy

  • Type II membrane proliferative glomerulonephritis

  • Chronic renal failure

Iatrogenic

Iatrogenic causes are as follows:

  • Excessive panphotocoagulation [7]

  • Scleral buckling

Systemic disorders that induce an occlusive vascular choroidal disorder

Such systemic disorders are as follows:

  • Pregnancy-induced hypertension (eclampsia/preeclampsia) [8]

  • Malignant hypertension [9]

  • Collagen vascular diseases

  • Disseminated intravascular coagulopathy

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