Senile Retinoschisis (RS) Clinical Presentation

Updated: Sep 07, 2018
  • Author: Brian A Phillpotts, MD, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

History

In the initial stages of senile retinoschisis, patients are generally asymptomatic; however, in the advanced stage of the disease, patients may complain of photopsia, floaters, and visual field loss.

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Physical

Examination of senile retinoschisis is completed by using indirect ophthalmoscopy with scleral depression. Goldmann lens/slit lamp biomicroscopy examination also may be performed. Examination reveals the following findings:

  • A retinal elevation is present in the middle to the peripheral part of the retina, often in the lower temporal quadrant. In a long-term follow-up study of retinoschisis in elderly patients, the inferior temporal retinal quadrant had the most involvement at 44%. [1]
  • The elevated retinal surface is usually smooth, without folds/undulation, and may contain retinal blood vessels.
  • The inner layer may be transparent and difficult to visualize.
  • In advanced cases, the leading edge of the splitting retinal layers usually elevate acutely, resulting in a bullous cystic cavity.
  • The position of the schisis cavity is constant in shape, elevation, and position; it changes with head position without fluid shift.
  • Scleral depression fails to collapse the inner retinal layer.
  • Scleral depression reveals white-without-pressure of the outer retinal layer.
  • The retinoschisis rarely extends into the macular region.
  • Senile retinoschisis is not associated with operculated or horseshoe-shaped retinal tears.
  • Retinal detachments secondary to outer retinal layer holes alone tend to be shallow, small, and located around senile retinoschisis.
  • Retinal detachments secondary to inner retinal layer holes alone or combined with outer layer holes tend to be elevated and large to total detachments.
  • Senile retinoschisis is commonly bilateral but not necessarily symmetrical.
  • Outer layer holes are usually large, relatively limited in number, and obvious; inner layer holes are usually small, numerous, and not so obvious.
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Causes

Preexisting peripheral cystoid degeneration

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Complications

A low clinical risk exists of retinal detachment or extension into the posterior pole, leading to an absolute field defect.

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