QuestionSBA
QuestionChoice
A cataract is an opacity of the lens of the eye and is usually a gradual age-related process. Presentation is usually with gradual blurring of the vision. Whilst diabetes is a risk factor for cataracts; this history is too acute
32616
d
Cataract
QuestionChoice
This is a reasonable differential diagnosis; however, as he has never suffered with this before, this would need to be a diagnosis of exclusion given the patient's age and comorbidities
32614
b
Ocular migraine
QuestionChoice
This is a classic history suggestive of retinal detachment. Risk factors for exudative retinal detachment include hypertension, vasculitis and macular degeneration, whereas myopia is a cause for tractional detachment. Other causes of detachment may be traumatic in nature, allowing fluid to pass from the vitreous space into the subretinal space
32613
a
Retinal detachment
QuestionChoice
This is the most prevalent degenerative condition of the retina and usually presents with night blindness followed by daytime peripheral and central visual loss. This does not fit with the acute clinical picture here
32617
e
Retinitis pigmentosa
QuestionChoice
This would be a differential and is important to exclude; however, it is less common, and the history is more suggestive of retinal detachment. Retinal artery occlusion usually presents with dramatic visual loss within seconds of occlusion. It should be considered a form of stroke as it is often thromboembolic in origin. Therefore the risk factors are similar to other causes of stroke (smoking, heart disease, atrial fibrillation, diabetes, hypercholesterolaemia)
32615
c
Retinal artery occlusion
QuestionComment
I thought that retinal detachment typically caused progressive lateral vision loss, and vascular causes lead to top-down vision loss? confusing. 
20636
QuestionComment
same
28774
User
subscriber
Poisoning Vaccine
QuestionComment
yeah top down vision as in a curtain coming down
47551
User
subscriber
Retrograde Recessive
User
subscriber
Lateral Endoscope
Concept
Chapter
# Summary

Retinal detachment is a medical condition referring to the separation of the retina from the retinal pigment epithelium (RPE), commonly caused by trauma. Characterized by symptoms such as floaters, photopsia, reduced visual acuity and visual field impairment, this condition can cause irreparable sight loss if the detachment progresses to the macula. Diagnosis can be confirmed through a variety of examinations and tests, such as fundoscopy, ultrasound or optical coherence tomography. Management strategies include surgical and non-surgical treatments like laser therapy, cryotherapy, vitrectomy, scleral buckling and pneumatic retinopexy.

# Definition

Retinal detachment is a medical condition that refers to a separation of the retina from the retinal pigment epithelium (RPE). There are different types of retinal detachment, but the most common is rhegmatogenous retinal detachment, commonly caused by trauma.

# Epidemiology

Epidemiological data on retinal detachment varies, but it is generally agreed that the condition is more common in individuals over the age of 40 and in those with a history of severe myopia or previous eye surgery.

# Aetiology 

Retinal detachment can occur due to a variety of causes, including:

- Trauma, which can create tears or holes in the retina
- Severe myopia, which can thin the retina and make it more prone to tears
- Previous eye surgery, particularly cataract surgery
- Certain diseases, such as diabetes or sickle cell disease
- Age-related changes in the vitreous, which can pull the retina away from the back of the eye

# Signs and Symptoms

Patients with retinal detachment may present with the following symptoms:

- Floaters
- Photopsia (flashes of light)
- Progressive and rapidly reduced visual acuity and visual field loss
- Painlessly in most cases

The danger is that if the detachment progresses to the macula, sight may be irreparably lost.

# Differential Diagnosis

The main differentials for retinal detachment include:

- Posterior vitreous detachment: Characterized by floaters, light flashes, and a ""cobweb"" effect in vision
- Age-related macular degeneration: Symptoms include blurred or reduced central vision, distorted vision, and difficulty reading or recognizing faces
- Vitreous hemorrhage: Presents with sudden loss of vision, floaters or shadows in the field of vision

# Investigations 

To diagnose retinal detachment, a variety of examinations and tests may be used, such as:

- Fundoscopy: To visually inspect the back of the eye 
	- One of the key findings to note in retinal detachments is if the macula is attached **(macula-on)** or macula-detached **(macula-off).** It is the status of the macula that defines the urgency with which surgical repair should be undertaken
- Ultrasound: To get a detailed image of the eye
- Optical coherence tomography: To provide cross-sectional images of the retina

# Management

There are various surgical and non-surgical treatments available for retinal detachment, depending on the extent of the condition. If the macula remains attached, there should be greater urgency to act faster as any vision-loss may still be salavagable, with poorer outcomes for macula-off RD. These include:

- Laser therapy or cryotherapy: To seal retinal tears or holes
- Vitrectomy: To remove the vitreous and replace it with a gas bubble or silicone oil
- Scleral buckling: To push the sclera toward the retinal tear
- Pneumatic retinopexy: To push the retina back into place using a gas bubble.
806
1004
Retinal detachment
Topic
16
Ophthalmology
6523
Painless visual loss described as a curtain falling is characteristic of retinal detachment, often associated with myopia and diabetic retinopathy.
A 58-year-old male presents to the Emergency Department with painless visual loss that he describes as a curtain coming down over his vision. He has never had this happen before. His only past medical history is well-controlled diabetes, and he is short-sighted.

What is the most likely diagnosis?
a