Prehospital Care
When patients with retinal detachment or their family member contacts their physician, they should be advised to do the following:
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Keep the patient NPO (absolutely no solid foods or fluids) in anticipation of retinal surgery
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In cases of associated trauma, protect the globe with metallic eye shield
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Avoid any pressure on the globe and to limit activity to a minimum until further evaluation
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. Please see the examination guidelines as stated above.
In difficult cases, bedside ocular ultrasonography can facilitate prompt diagnosis of retinal detachment. Potential ultrasonographic mimics of retinal detachment (eg, posterior vitreous detachment [PVD] and vitreous hemorrhage [VH]) should be excluded.
Patient follow up should be based upon macula status: Whenever a macula-on retinal detachment is suspected, a retina specialist should evaluate the patient within 24 hours.
All patients should be instructed to limit strenuous physical activity. Upon discharge from the ED, patients should be provided with the name and contact information for a retina specialist located close to their home.
There exists a multitude of techniques for treating retinal detachments, including scleral buckling, pars plana vitrectomy, and pneumatic retinopexy. The retinal detachment repair is usually done on an outpatient basis.
Consultations
Ideally, patients with retinal detachment should be quickly referred to a retina specialist. The timing of surgical intervention is typically based on the status of the macula.
Further Inpatient Care
Immediate ophthalmologic referral is mandatory for patients with retinal detachment.
Transfer
Emergent transfer to a facility with an available retina specialist is rarely indicated, as majority of cases can be evaluated within 24 hours. In some cases, transfer to a facility with an available ophthalmologist or retinal specialist is in the patient's best interest after initial ophthalmologic evaluation. Make these decisions in accordance with the patient's wishes and the direction of the ophthalmology consultant.
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Anatomy of the eye.
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Retinal detachment. Courtesy of Kresge Eye Institute, Detroit, Michigan.
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Retinal detachment. Courtesy of Kresge Eye Institute, Detroit, Michigan.
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Retinal detachment. Courtesy of Kresge Eye Institute, Detroit, Michigan.
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Retinal detachment. Courtesy of Kresge Eye Institute, Detroit, Michigan.
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Retinal detachment. Courtesy of Kresge Eye Institute, Detroit, Michigan.
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Retinal detachment. Courtesy of Kresge Eye Institute, Detroit, Michigan.
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Sonogram of retinal detachment. Courtesy of Bruce Lo, MD.
