Retinal detachment
Rhegmatogenous retinal detachment is a surgical emergency in which a full-thickness retinal break lets liquefied vitreous separate the neurosensory retina from the retinal pigment epithelium, presenting with flashes, floaters, and an advancing visual field curtain. Diagnosis is by dilated indirect ophthalmoscopy with scleral depression, and treatment is prompt surgical reattachment, most urgent while the fovea is still spared.
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What this article covers
- Overview
Rhegmatogenous retinal detachment is a full-thickness break in the neurosensory retina that lets liquefied vitreous track behind it, separating the retina from the underlying retinal pigment epithelium (RPE) and choroid.
- Epidemiology
Advancing age is the dominant demographic driver, tracking the age-related rise in posterior vitreous detachment.
- Risk factors
High myopia, through axial elongation, peripheral retinal thinning, and lattice degeneration.
- Pathophysiology
A retinal break (tear or hole) allows liquefied vitreous to pass through the neurosensory retina into the potential space between retina and RPE, the anatomic first step in rhegmatogenous detachment.
- Clinical features
Flashes of light (photopsias) and floaters are the earliest and most sensitive symptoms, generated by vitreoretinal traction; new photopsias signal an evolving tear and merit urgent evaluation before progression to detachment.
- Differential diagnosis
Retinal tear without detachment – flashes and floaters with a break confirmed on scleral-depressed exam but no subretinal fluid; treated prophylactically with laser or cryopexy.
- Diagnosis
Retinal detachment is a clinical-examination diagnosis confirmed by direct visualization of the detached retina: dilated indirect ophthalmoscopy with scleral depression identifies the break and the…
- Management
First, refer emergently to ophthalmology and keep the patient at rest until definitive surgical repair, since bed rest can slow further extension of subretinal fluid while awaiting surgery.
- Complications
Permanent central vision loss if the macula detaches before repair; the principal reason macula-on status drives urgency.
- Prognosis
Macula-on detachments repaired promptly have the best chance of full visual recovery, since the fovea has not yet lost its choroidal blood supply.
- Prevention
Any patient with new-onset flashes or floaters should receive an urgent, same-day dilated fundus examination with scleral depression, to identify and treat an asymptomatic retinal tear before it progresses to detachment.
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A full-thickness break in the peripheral retina, usually caused by vitreoretinal traction as the vitreous separates from the retina, that is the precursor lesion to rhegmatogenous retinal detachment. New flashes and floaters mandate same-day dilated indirect ophthalmoscopy with scleral depression, and a confirmed tear is treated urgently with laser photocoagulation or cryotherapy to seal and repair it before subretinal fluid tracks through and detaches the retina.
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