Retinal detachment
Retinal detachment: Excerpt from Handbook of Diseases
When the sensory retina splits from the retinal pigment epithelium, retinal detachment occurs, creating a subretinal space. This space then fills with fluid, called subretinal fluid. Retinal detachment usually involves only one eye but may involve the other eye later.
Surgical reattachment is often successful. However, the prognosis for good vision depends on the area of the retina that’s been affected.
Causes
Any retinal tear or hole allows the liquid vitreous to seep between the retinal layers, separating the retina from its choroidal blood supply. In adults, retinal detachment usually results from degenerative changes of aging, which cause a spontaneous retinal hole.
Predisposing factors include myopia, cataract surgery, and trauma. 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 (from 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), or trauma. It can also be inherited, usually in association with myopia.
Signs and symptoms
Initially, the patient may complain of floating spots and recurrent flashes of light. But 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
Ophthalmoscopy after full pupil dilation allows diagnosis. Examination shows the usually transparent retina as gray and opaque; with severe detachment, it reveals folds in the retina and a ballooning out of the area. Indirect ophthalmoscopy is used to search for retinal tears. Ultrasonography is performed if the lens is opaque.
Treatment
Depending on the location and severity of the detachment, treatment may include restriction of eye movements and complete bed rest to prevent further detachment.
A hole in the peripheral retina can be treated with cryothermy; in the posterior portion, with laser therapy. Retinal detachment usually requires scleral buckling to reattach the retina and, possibly, replacement of the vitreous with oil, air, gas, or silicone.
Special considerations
❑ Provide emotional support; the patient may be distraught because of his decreased vision.
❑ To prepare for surgery, wash the patient’s face with baby shampoo. Administer an antibiotic and cycloplegic-mydriatic eyedrops.
❑ After surgery, instruct the patient to lie in the position that facilitates the gas or oil to tamponade the retina. This may be a prone position. Discourage straining during defecation, bending down, and coughing hard, sneezing, or vomiting, which can raise intraocular pressure. An antiemetic may be indicated. Discourage activities that increase the risk of bumping the eye.
❑ After removing the protective patch, gently clean the eye with cycloplegic eyedrops and steroid-antibiotic eyedrops.
❑ Use cold compresses to decrease swelling (postoperative edema) and pain.
❑ Administer an analgesic, such as acetaminophen, as needed, noting persistent pain.
❑ Teach the patient how to properly instill eyedrops, and emphasize compliance and follow-up care.
CLINICAL TIP: Encourage wearing dark glasses to compensate for sensitivity to light.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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» Next page: Vascular retinopathies (Handbook of Diseases)
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