Retinal Detachment

Introduction to
Retinal Detachment
Motasem Al-latayfeh, M.D.
Hashemite University
Department of Ophthalmology
•Definition :
Separation of the neurosensory

retina (NSR) from the retinal
pigment epithelium.
IMPORTANT FACTS TO REMEMBER:
•The retina is derived from the optic vesicle which invaginates during
the fourth fetal week to form the optic cup.
•The inner wall of which differentiates into the multilayered NSR.
•The outer wall of the cup becomes the pigment epithelium (RPE).
• NSR is a continuous sheet of tissue that extends from Optic
Nerve to Ora Serrata.
• Firmly Attached at Ora Serrata & Optic Nerve.
NO TRUE ADHESION
BETWEEN NSR AND RPE.
FORCES OF NSR-RPE
ATTACHMENT:
• Transretinal Fluid Gradient.
• Interphotoreceptor Matrix. Acts as Glue
• Suction forces of RPE Pump.
• Hydrostatic Intraocular Pressure.
• Viscoelastic tamponade of Vitreous Gel.
• Choroidal Concentration gradients.
EVALUATION TECHNIQUES
TYPES OF RETINAL
DETACHMENT
• Rhegmatogenous RD is caused by a retinal break which
permits SRF derived from synchitic (liquefied) vitreous
to gain access to the subretinal space.
• Non-rhegmatogenous RD is not caused by a retinal

break. The two types are:
• Tractional in which the sensory retina is pulled away from the
RPE by contracting vitreoretinal membranes.
• Exudative (serous, secondary), in which SRF derived from the

choroid gains access to the subretinal space through damaged
RPE.
MECHANISM OF RETINAL
DETACHMENT:
• Vitreoretinal Traction:
• Dynamic traction:
• is induced by rapid eye movements.
• exerts a centripetal force towards the vitreous cavity.
• It plays an important role in the pathogenesis of retinal tears and
rhegmatogenous RD.
Static traction:
•It plays an important role

in the pathogenesis of
tractional RD and
proliferative
vitreoretinopathy.
•It can be: Tangential,

Anteroposterior and
Bridging traction.
DETACHMENT:
Rhegmatogenous RD:
• Retinal breaks + accumulation of subretinal fluid
• Retinal breaks result from dynamic vitreoretinal tractions (PVD) and
peripheral retinal degenerations.
DYNAMIC VITREORETINAL
TRACTIONS:
Normal Vitreoretinal adhesions

DYNAMIC VITREORETINAL
TRACTIONS:
• Pathology: Vitreous liquifaction (synchysis).
• Liquid vitreous may gain access into the subhyaloid space.
• Fluids accumulate in the subhyaloid space and result in

POSTERIOR VITREOUS DETACHMENT (PVD).
ACUTE POSTERIOR VITREOUS DETACHMENT: (A) SYNCHISIS; (B)
UNCOMPLICATED POSTERIOR VITREOUS DETACHMENT; (C) RETINAL TEAR
FORMATION AND VITREOUS HAEMORRHAGE; (D) AVULSION OF A RETRNAL
BLOOD VESSEL AND VITREOUS HAEMORRHAGE
COMPLICATIONS OF PVD:
• No complications: most of the time
• Retinal tears:
• 10-15% of cases
• Associated with vitreous hemorrhage
• Risk of RD is high
• Avulsion of retinal blood vessel and vitreous hemorrhage without
tear.
VITREOUS TRACTION AT THE POSTERIOR ASPECT OF
THE VITREOUS BASE PREDISPOSES TO RETINAL
BREAKS AT THIS LOCATION.
DETACHMENT:
Tractional retinal detachment:
• e.g. Diabetic tractional RD, Proliferative

vitreoretinopathy, sickle cell retinopathy and
retinopathy of prematurity.
• Results from active static vitreoretinal traction.

TRACTIONAL RD IN PROLIFERATIVE DIABETIC
RETINOPATHY
Tractional RD in proliferative diabetic retinopathy
3- Exudative RD:
• disorders that disrupt the retinal pigment epithelium and
allow the choroidal fluid to accumulate in the subretinal
space
Causes:
• Choroidal tumors
• Intraocular inflammation
• Iatrogenic : RD surgery
• Subretinal neovascularizations
CLINICAL FEATURES:
Rhegmatogenous RD:
• Symptoms:
• flashes of light (Photopsia)
• Vitreous floaters (ring-shaped, cobweb, and shower of
floaters)
• Peripheral visual loss: relative scotoma
• Signs:
• Relative afferent papillary defect
• Low IOP
• Vitreous opacities (tobacco dust).
• Retinal breaks
• Retinal appearance: convex corrugated and undulating
surface
FRESH BULLOUS SUPERIOR RETINAL DETACHMENT
RETINAL TEAR WITH RETINAL DETACHMENT
CLINICAL FEATURES:
Tractional RD:
• Symptoms: photopsia and floaters are
absent, slowly progressive visual field loss.
• Signs:
• Concave immobile surface.
• Absent retinal breaks
INFERIOR TRACTIONAL RETINAL DETACHMENT
COMBINED TRACTIONAL AND RHEGMATOGENOUS RD
EXUDATIVE RETINAL
DETACHMENT:
• Symptoms: photopsia is absent but floaters

are present (vitritis), visual field loss.
• Signs:
• Convex, smooth not corrugated and mobile.
• Shifting of subretinal fluid
• Absent retinal breaks
EXUDATIVE RETINAL DETACHMENT IN VKH
DIFFERENTIAL DIAGNOSIS OF
RETINAL DETACHMENT:
Choroidal Detachment
•The intraocular pressure may be very low as a resultof
concomitant detachment of the ciliary body.
•The brown elevations are convex, smooth, bullous and
relatively immobile.
•The peripheral retina and ora serrata can be seen with ease
without scleral indentation.
•The elevations do not extend to the posterior pole because
they are limited by the firm adhesion between the
suprachoroidal lamellae where the vortex veins enter their
scleral canals.
CHOROIDAL
DETACHMENT
RETINOSCHISIS
• Retinoschisis occurs when the retina is split into two
layers.
• Retinoschisis may present with a bullous and
smooth, dome-shaped .
• The underlying RPE is typically normal and devoid
of demarcation lines.
• Tobacco dust, vitreous hemorrhage, or flap tears are
not expected to be present .
• Retinoschisis and retinal detachment can potentially
both occur in the same eye independent of one
another.
RETINOSCHISIS
MANAGEMENT OF RRD
• General treatment measures include the following:
• NPO status in anticipation of retinal surgery
• In trauma cases, protection of the globe with a metallic
eye shield
• Limitation of activity to a minimum until further evaluation
• Referral to a retina specialist.
• Specific techniques for treating retinal detachments
include the following:
• Scleral buckling
• Pars plana vitrectomy
• Pneumatic retinopexy
• Prognosis for Management depends on :
• Duration of detachment
• State of the Macula
THANK YOU………….

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Introduction to

Separation of the neurosensory

•The inner wall of which differentiates into the multilayered NSR.

• Firmly Attached at Ora Serrata & Optic Nerve.

• Non-rhegmatogenous RD is not caused by a retinal

• Exudative (serous, secondary), in which SRF derived from the

•It plays an important role

•It can be: Tangential,

Normal Vitreoretinal adhesions

• Liquid vitreous may gain access into the subhyaloid space.

• Fluids accumulate in the subhyaloid space and result in

• e.g. Diabetic tractional RD, Proliferative

• Results from active static vitreoretinal traction.

• Symptoms: photopsia is absent but floaters

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