Senile Retinoschisis (RS) Clinical Presentation

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



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.


Preexisting peripheral cystoid degeneration



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