Retinal detachment

1. PEER PRESENTATON
ON
RETINAL
DETACHMENT
Presented by:
Ms. Omoty Tatin
Msc (N) 1st year
Regn: 202363008

2. OBJECTIVES:
At the end of the class the students will be
able to :
1. Define Retinal detachment
2. List the causes and risk factors
3. Explain the pathology and
Pathophysiology
4. List the symptoms
5. Enumerate the types

3. 6. List the diagnostic evaluation and
principles of treatment
7. Discuss the Medical, Pharmacologic and
surgical management
8. List the complications
9. Discuss the nursing responsibilities and
coping and supportive measures

5. INTRODUCTION:
The role of vision in our lives is difficult to
define, because it is so deeply personal and
intimate.
Loss of vision means loss of independence.
Among the various cause of blindness,
retinal detachment is one which is an ocular
emergency.

6. DEFINITION:
Retinal detachment is a disorder of the
eye in which the retina peels away from
its underlying layer of support tissue.

8. INCIDENCE:
The average incidence of RRDs among
males was 7.99 cases per 100 000 and
among females was 7.56 cases per 100 000
in China.
The incidence of retinal detachment has
been reported between 0.04% and 0.36%
by previous studies.

9. CAUSES:
Spontaneous due to degenerative changes
in the retina or vitreous
Trauma, inflammation or other problems
Older than 40
Common cause is the tear or hole in the
retina,

10. Diabetic retinopathy
Previous retinal detachment in the other
eye
Family history of retinal detachment
Metabolic and vascular diseases
Severe myopia

11. RISK FACTORS:
Aging
Previous retinal detachment in one eye
Family history of retinal detachment
Extreme nearsightedness (myopia)

12. Previous eye surgery
Previous severe eye injury
Previous other eye disease or disorder

13. PATHOPHYSIOLOGY

14. Due to etiological factors (a torn or break in
retina)
Vitreous fluid or serous fluid leaks in
between the layers of retina or behind the
retinal layers
Detachment of retinal layer

15. Retina can peel away from the underlying
layer of blood vessels
Lack of oxygenation in tissues of retina
Vision disturbances

16. SYMPTOMS:
The sudden appearance of many floaters
Flashes of light in one or both eyes
(photopsia)
Blurred vision
Gradually reduced side (peripheral) vision
A curtain-like shadow over the field of vision

17. FLOATERS

18. PHOTOPSIA

19. CURTAIN LIKE SHADOW

20. TYPES:
1. Rhegmatogenous
2. Tractional
3. Exudative

21. RHEGMATOGENOUS
It occurs due to break in the retina (called
a retinal tear)

22. TRACTIONAL
It occurs when scar tissue grows on the
retina's surface, causing the retina to pull
away from the back of the eye

23. EXUDATIVE
It occurs due to inflammation, injury or
vascular abnormalities.
Fluid accumulating underneath the
retina without the presence of a hole,
tear or break.

26. DIAGNOSIS:
History
 Physical Examination
 Checking of visual acuity
 External examination for signs of
trauma and checking of the visual field.
 Assessment of pupil reaction

27. Measurement of intraocular pressure in
both eyes.
Slit lamp examination
Ultrasound imaging
Visual acuity Measurement

28. SLIT LAMP EXAMINATION:

29. VISUAL ACUITY MEASUREMENT:
SNELLEN CHART

30. TREATMENT:
General principles of treatment:
Find all retinal beaks
Seal all retinal breaks
Relieve vitreo retinal traction

31. MANAGEMENT:
Sedation ( local anesthesia)
 Bed rest for 2 to 4 weeks and eye patch
Restricted eye movement

32. PHARMACOLOGIC INTERVENTION
Drops as prescribed of Cyclopentolate
hydrochloride (Cyclogyl)
Antibiotic drops such as Gentamicin;
prednisolone acetate to prevent eye
infections
Other Drugs: Antiemetics and analgesics

33. SURGICAL MANAGEMENT
Cryotherapy or Laser surger(photocoagulation)
Freezing (cryopexy)
Electrodiathermy
Pneumatic retinopexy
Scleral buckling
Vitrectomy

34. CRYOTHERAPY OR LASER SURGERY

35. FREEZING (CRYOPEXY)

36. ELECTRODIATHERMY
A tiny hole is made in the sclera to
drain subretinal fluid, allowing the
pigment epithelium to adhere to the
retina.

37. PNEUMATIC RETINOPEXY

38. SCLERAL BUCKLING

39. VITRECTOMY

40. COMPLICATIONS

41. Early complication- Glaucoma,
infections, failure of retina to reattach
Late complications- Infection, diplopia,
refractive errors
Re-enactment of the retina may
occur any time.

42. Due to postoperative swelling of tissue
in anterior chamber leads to increased
intraocular pressure in glaucoma.
Due to the retina separated from blood
supply for a long time even after
reattachment patients vision does not
improve

43. NURSES
RESPONSIBILITIES
Pre-operative:
Provide emotional support to the patient
Instruct the patient to remain quiet in
prescribed position
Allow the patient and family to discuss
their concerns.

44. Prepare the patient by cleaning his face
and administer preoperative medications
as ordered.
Post-operative:
Assess the status of eye dressing and
presence of bleeding or drainage.

45. Place the patient in fowler or semi-fowler’s
position to reduce the intraocular pressure.
Take measures to prevent postoperative
complications
Encourage ambulation and independence as
tolerated.
Administer medication for pain, nausea, and
vomiting as directed

46. NURSING DIAGNOSIS:
Acute pain related to trauma to the
incision site and increased intraocular
pressure
Impaired sensory perception vision
related to impaired sensory reception

47. Anxiety related to lack of knowledge
about the disease and its treatment
High risk of injury related to loss of
vitreous, intraocular hemorrhage and IOP
Risk for infection related to trauma to the
incision.

48. NURSING INTERVENTIONS
Assess visual status and functional vision
in the unaffected eye to determine self
care needs.
Discourage straining during defecation,
bending down and hard coughing,
sneezing or vomiting to avoid activities
that increase intraocular pressure.

49. Assist with ambulation, as needed, to help
the client remain independent
Provide assistance with activities of daily
living to minimize frustration and strain.
Orient the client to his environment to
reduce the risk of injury.

50. Discharge and Home
Healthcare
Guidelines

51. Have the patient or significant others
demonstrate the correct technique for
instilling eye drops.
Instruct the patient to wash her or his
hands before and after removing the
dressing.

52. Do not touch any part of the eye with the
dropper.
Teach the patient to use warm or cold
compresses for comfort several times a day.
Teach the patient to avoid vigorous activities
and heavy lifting for the immediate
postoperative period.

53. COPING AND SUPPORT
Get glasses.
Brighten the home
Make the home safer
Enlist the help of others
Get help from technology
Talk to others with impaired vision

56. CONCLUSION
Retinal detachment is a vision threatening
condition that requires early surgery. It can
be diagnosed best by retinal examination
usually indirect opthalmoscopy. Treatment
outcome has improved with modern
surgical techniques, but the key to
successful reattachment is early detection
and prompt referral by primary eye care
workers

57. BIBLIOGRAPHY

58. BOOKS:
 Correia C. Medical surgical Nursing- Nursing Speciality
as per INC syllabus. First Edition Vol 2; Jaypee Brothers
Medical Publishers (P) Ltd, New Delhi, 2017; Page no:
227-29
 Chintamani, Lewis’s Medical- Surgical Nursing-
Assessment and Management of clinical Problems. 7th
Ed; Reed Elsevier India Private Limited, New Delhi, 2011;
Page no: 424-26
 Reeves J. C, Roux G, Lockhart R. Medical-Surgical
Nursing. International Edition; McGraw Hill Nursing Core
Series, page no: 18
 Waugh A, Grant A. Ross and Wilson Anatomy and
physiology in illness and health, 12th Edition, Reed
Elsevier India Private Limited, New Delhi, 2014; Page no:
196- 205

59. INTERNET:
Mayo Clinic (7 Sept 2022), Retinal
Detachment; cited on 13/ 10/ 23;
Available from:
https://www.mayoclinic.org
Gabby E.A ( 12 April 2023), Retinal
Detachment, Edited by Amy Boshnack;
Cited on 13/10/13; Available from:
https://www.healthline.com

60. JOURNAL
 Paolo Chelazzi, Claudia Azzolini, Claudia Bellina,
Francesca Cappelli, Ilaria Del Genovese, Laura
Caraffa, Francesco Scullica, "Efficacy and Safety of
Vitrectomy without Using Perfluorocarbon Liquids
and Drainage Retinotomy Associated with
Postoperative Positioning Based on Residual
Subretinal Fluid for Rhegmatogenous Retinal
Detachment", Journal of Ophthalmology, vol. 2021,
Article ID 5588479, 9 pages, 2021. Available from:
https://doi.org/10.1155/2021/5588479