III-B.Sc (Nursing)

1. RETINAL DETACHMENT

4. DEFINITION
• Detachment of the sensory area of the retina
(rods and cones) from the pigmented epithelium
of the retina.
• A break in the continuity of the retina may first
occur from small degenerative holes and tears,
which may lead to detachment.

5. TYPES
There are three types of retinal detachment:
• Rhegmatogenous
• Tractional
• Exudative

6. Rhegmatogenous retinal detachment –
It occurs due to a break in the retina
(called a retinal tear)
Retinal breaks are divided into three types
– holes, tears and dialyses.

7. • Tractional retinal detachment –It occurs
when fibrous or fibro-vascular tissue, pulls
the sensory retina from the retinal
pigment epithelium.

9. Exudative, serous, or secondary retinal
detachment –It occurs due to inflammation,
injury or vascular abnormalities
Fluid accumulating underneath the retina
without the presence of a hole, tear, or break.
Rare

10. ETIOLOGY
• Eye trauma, inflammation or tumor
• Diabetic retinopathy
• Severe Myopia and loss of lens from cataract
(aphakia)
• Age (over 40 years)

11. • Retinal tear
• Family history
• Other eye diseases or disorders, such as
uveitis, degenerative myopia
• Complications from cataract surgery

12. PATHOPHYSIOLOGY

13. CLINICAL MANIFESTATION
• Retinal detachment occur slowly or rapidly, but
without pain.
• Flashes of light or blurred, ‘sooty’ vision.
Warning signs
Flashes of light (photopsia)
A sudden increase in the number of
eye floaters

14.  Blurred vision
 Seeing a shadow or a curtain descending
from the top of the eye or across,
commonly misinterpreted as a drooping
eyelid or elevated cheeks.

15. DIAGNOSTIC EVALUATION
History collection-
•History of trauma
•Previous ophthalmologic surgery
•Previous eye conditions (eg, uveitis and
vitreous hemorrhage)
•Duration of visual symptoms and visual
loss

16. • Physical examination
• Indirect ophthalmoscopy
• Slit lamp examination
• Three mirror gonioscopy magnify the
lesions

17. MANAGEMENT
General management:
Sedation
Bed rest and
Eye patch may be used to restrict eye
movements.

18. Surgical management
• Photocoagulation: a light beam(either laser or
xenon arc) is passed through the pupil, causing
a small burn and producing an exudate
between the pigment epithelium and retina to
coagulate and destroy or fuse small areas of
tissue, especially in the retina.

19. • Electrodiathermy: A electrode needle is passed
through the sclera to allow subretinal fluid to
escape. An exudate forms from the pigment
epithelium and adhers to the retina.
• Cryosurgery or retinal cryopexy: a
supercooled probe is touched to the sclera,
causing minimal damage; as a result of scarring,
the pigment epithelium adheres to the retina.

20. Scleral buckling: a technique whereby the sclera
is shortened to allow a buckling to occur, which
forces the pigment epithelium closer to the retina

21. COMPLICATION
• Glaucoma
• Infection