retinal detachment

Question 1

differential diagnoses for acute floaters and/or flashes?

Answer 1

• PVD
• retinal tear/detachment
• migraine (classic or ocular)
• posterior uveitis
• vitreous haemorrhage secondary to R3 (DR)

Question 2

symptoms of RD

Answer 2

• recent onset floaters
• recent flashes
• progressive field loss (curtain/shadow)
• reduction in VA

Question 3

how common is RD

Answer 3

10-15 per 100,000 people

Question 4

risk factors of RD

Answer 4

• age (~60 years)
• myopia
• previous tear/detachment
• family history
• recent eye surgery
• trauma

Question 5

what is rhegmatogenous RD?

Answer 5

a retinal tear or break develops allowing fluid to enter the subretinal space causing RD

Question 6

what is the most comon type of RD?

Answer 6

rhegmatogenous

Question 7

symptoms of PVD?

Answer 7

• recent onset floaters
• recent onset flashes
• often asymptomatic

Question 8

how common is PVD?

Answer 8

age-related
24% adults 50-59 and 87% of 80-89 year olds

Question 9

risk factors of PVD

Answer 9

• age
• myopia
• trauma
• intraocular inflammation

Question 10

what causes a PVD?

Answer 10

a change in the relative proportions of gel and liquid compartments in the vitreous causing a separation between the posterior hyaloid and the retina

Question 11

likelihood of a retinal tear following a PVD?

Answer 11

14%

Question 12

what happens to the photoreceptors when the RPE detaches?

Answer 12

they die VVV quickly
therefore emergency referral

Question 13

what is a weiss ring?

Answer 13

a small amount of tissue from the optic disc that has been pulled away as the vitreous has detached

Question 14

common sign of PVD?

Answer 14

weiss ring floater

Question 15

H&S questions to ask ?

Answer 15

• risk factors
• photopsia characteristics, duration and laterality
• size, shape and distribution of floaters
• onset, nature and duration of change in vision

Question 16

what qs do you ask the px in H&S to check for risk factors?

Answer 16

• myopia
• recent ocular surgery
• blunt trauma
• diabetes
• systemic inflammatory condition

Question 17

if px is complaining of intermitted WHITE flashes of light in termporal visual field, what is this likely to be?

Answer 17

vitreo-retinal traction

Question 18

if px is complaining of coloured lights and zig-zag lines in the visual field of 1 or 2 eyes simultaneously and lasts for mintes or hours at a time, what is this likely to be?

Answer 18

neurovascular origin (migraines)

Question 19

what is a tell-tale sign of RD?

Answer 19

curtain/veil
progressively enlarging shadow starting peripherally and advancing centrally

Question 20

are symptoms a good predictor of a retinal tear?

Answer 20

not really (unless a shadow/curtain/veil)

Question 21

what clinical tests would you do to detect RD?

Answer 21

• vision
• confrontation VF (NOT ON A MACHIINE - USELESS IN RD)
• RAPD
• IOP
• shafers
• dilated fundus exam

Question 22

what is shafers sign?

Answer 22

retinal pigment in the anterior vitreous

Question 23

how does shafers sign occur?

Answer 23

when there is a break in the retina, RPE cells migrate forwards to anterior

Question 24

what is shafers sign also called?

Answer 24

tobacco dust

Question 25

if a px is shafers +ve, what is the likelihood they have a retinal tear?

Answer 25

88%

Question 26

what is a horseshoe tear?

Answer 26

full thickness break in the neurosensory retina that occurs secondary to vitreous traction

Question 27

does a px have symptoms with an atrophic hole?

Answer 27

often asymptomatic

Question 28

does having an atrophic hole make you more likely to have RD?

Answer 28

no - therefore can observe

Question 29

which disease do you see tractional RD?

Answer 29

proliferative retinopathy (DR, sickle cell anemia, and other diseases leading to neovas in retina)

Question 30

what causes tractional RD?

Answer 30

fibrovascular membranes on the surface of the retina or vitreous pull on the neurosensory retina

Question 31

what are the 2 treatment options for retinal tears?

Answer 31

retinopexy LASER OR CRYOTHERAPY

Question 32

when managed optimally, what % of RD can be repaired with single intervention?

Answer 32

80-90%

Question 33

treatment of complicated RD?

Answer 33

- scleral buckling - vitrectomy - pneumatic retinopexy

Question 34

what is scleral buckling?

Answer 34

a piece of 'sponge' or 'rubber band' is placed on the sclera to create an indent and move it closer to the retina may need to drain away excess SRF before doing the procedure

Question 35

GOC says, if you suspect a retinal break or tear, what is the minimum you should do?

Answer 35

- detailed H&S - examine anterior vitreous for shafers - perform a dilated fundus examination using an indirect viewing technique - give appropriate advice to the px which you back up with written info

Question 36

GOC says you can do an emergency referral, if there is....

Answer 36

- retinal detachment - positive shaffers sign - vitreous, retinal or pre-retinal haemorrhage - lattice degeneration or retinal break with symptoms