Retinal detachment
Retinal detachment: Excerpt from Professional Guide to Diseases (Eighth Edition)
Retinal detachment occurs when the outer retinal pigment epithelium splits from the neural retina, creating subretinal space. This space then fills with fluid, called subretinal fluid. Retinal detachment usually involves only one eye, but may later involve the other eye. Surgical reattachment is usually successful. However, the prognosis for good vision depends on which area of the retina has been affected.
Causes and incidence
Any retinal tear or hole allows the liquid vitreous to seep between the retinal layers, separating the retina from its choroidal blood supply. Predisposing factors include myopia, intraocular surgery, and trauma. In adults, retinal detachment usually results from degenerative changes of aging, which cause a spontaneous retinal hole. Perhaps the influence of trauma explains why retinal detachment is twice as common in males. Retinal detachment may also result from seepage of fluid into the subretinal space (because of inflammation, tumors, or systemic diseases) or from traction that’s placed on the retina by vitreous bands or membranes (due to proliferative diabetic retinopathy, posterior uveitis, or a traumatic intraocular foreign body).
Retinal detachment is rare in children, but occasionally can develop as a result of retinopathy of prematurity, tumors (retinoblastomas), trauma, or myopia (which tends to run in families).
In the United States, approximately 10,000 people per year are affected by retinal detachments.
Signs and symptoms
Initially, the patient may complain of floating spots and recurrent flashes of light (photopsia). However, as detachment progresses, gradual, painless vision loss may be described as a veil, curtain, or cobweb that eliminates a portion of the visual field.
Diagnosis
Confirming diagnosis Diagnosis depends on ophthalmoscopy after full pupil dilation. Examination shows the usually transparent retina as gray and opaque; in severe detachment, it reveals folds in the retina and ballooning out of the area. Indirect ophthalmoscopy is used to search for retinal tears. Ultrasound is performed if the lens is opaque.
Treatment
Treatment depends on the location and severity of the detachment. It may include restriction of eye movements and complete bed rest until surgical reattachment is done. A hole in the peripheral retina can be treated with cryothermy; in the posterior portion, with laser therapy. Retinal detachment usually requires a scleral buckling procedure or a vitrectomy to reattach the retina. Basic salt solution is used to replace the retina while the vitreous is removed.
Certain types of uncomplicated retinal detachment may be treated by pneumatic retinopexy, in which an expansile gas is initially injected into the vitreous cavity and the patient’s head is positioned to facilitate retina reattachment. This procedure can be performed under local anesthesia.
Special considerations
❑ Provide emotional support because the patient may be understandably distraught about his loss of vision.
❑ During transportation, position the patient’s head so that the detached portion of the retina will fall back with the aid of gravity.
❑ To prepare for surgery, wash the patient’s face with no-tears shampoo. Give antibiotics and cycloplegic-mydriatic eyedrops.
❑ Postoperatively, position the patient facedown on his right or left side and with the head of the bed raised. Discourage straining at stool, bending down, hard coughing, sneezing, or vomiting, which can raise intraocular pressure. Antiemetics may be indicated.
❑ Protect the patient’s eye with a shield or glasses.
❑ To reduce edema and discomfort, apply ice packs as ordered. Administer pain medication, as ordered, for eye pain.
❑ After removing the eye shield, gently clean the eye with cycloplegic eyedrops and administer steroid-antibiotic eyedrops, as ordered. Use cold compresses to decrease swelling and pain.
❑ Administer analgesics as needed, and report persistent pain. Teach the patient how to properly instill eyedrops, and emphasize compliance and follow-up care. Suggest dark glasses to compensate for light sensitivity caused by cycloplegia.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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