Blood-vessel orientation in the detached portion of the retina differs from that in the normal retina.The detached retina floats freely in the vitreous body, and moves with eye movements.A retinal tear may potentially be visible (e.g., horseshoe, linear, or round retinal tears).Opthalmoscopic findings: A freshly detached retina has a grey color instead of the normal pink color and may appear crinkled.Indirect retinoscopy is useful to visualize the peripheral retina. References: Pathophysiologyīoth direct and indirect ophthalmoscopy should be performed after dilating the pupil. Sudden decrease in intra-ocular pressure due to perforating injuries or intraocular surgery.Scar tissue following penetrating injury.Peripheral retinal breaks, commonly due to:.Previous intraocular surgery (e.g., cataract surgery).Subretinal fluid accumulation without retinal tears.Formation of vitreoretinal bands → traction on the vitreoretinal band during eye movements or as a result of sudden decrease in intraocular pressure → retinal detachment.Retinal tears → retinal fluid, which is formed by vitreous degeneration, seeps into the subretinal space → retinal detachment.Visual prognosis depends particularly on the extent of retinal detachment (poor with macular involvement) and how much time passes before the retina is reattached. Extensive retinal detachment is an ophthalmic emergency and usually requires prompt surgery to prevent further detachment and restore sensory function. To prevent retinal detachment, laser photocoagulation in the direct vicinity of the retinal defect should be performed after diagnosis of retinal tears or holes. The diagnosis is confirmed by ophthalmoscopy. Loss of vision may be severe if the retinal detachment is extensive and/or the macula is affected. Small detachments typically present with photopsia, floaters, and/or visual field defects. Non-rhegmatogenous retinal detachment is most often the result of vitreoretinal bands (e.g., proliferative diabetic retinopathy), subretinal/intraretinal tumors (e.g., choroidal melanoma), or a number of systemic and ocular causes that result in subretinal fluid accumulation. Less commonly, retinal detachment occurs without any retinal tears ( non-rhegmatogenous retinal detachment). The most frequent causes of retinal detachment are tears or holes in the retina ( rhegmatogenous retinal detachment), risk factors for which include myopia, previous intraocular surgery, trauma, and/or posterior vitreous detachment. Exudative detachments result from fluid accumulation beneath the sensory retina caused by retinal or choroidal diseases.Ĭopyright © 2023, StatPearls Publishing LLC.Retinal detachment refers to the detachment of the inner layer of the retina (neurosensory retina) from the retinal pigment epithelium. Components of rhegmatogenous and tractional etiologies may also lead to retinal detachment. Tractional detachments occur when proliferative membranes contract and elevate the retina. Rhegmatogenous retinal detachments are the most common and are caused by fluid passing from the vitreous cavity via a retinal tear or break into the potential space between the sensory retina and the RPE. There are three categories of retinal detachment: rhegmatogenous, tractional, and exudative. However, if the macula comes off, vision may remain poor despite surgical intervention. Vision is potentially retainable if the macula remains attached, and the retina gets appropriately reattached. A detachment of the macula can lead to permanent damage to the photoreceptors in this location. Within the fovea, there are no retinal blood vessels, and retinal tissue within this area depends entirely on the choroid for its oxygen requirements. The choroid supplies the oxygen and nutrition for the photoreceptors. The outer portion of the neurosensory retina is where the photoreceptors lie. Retinal detachment is when the neurosensory retina loses adherence to the underlying retinal pigment epithelium (RPE). The outermost layer abuts the vitreal cavity and the innermost layer, the choroid. It is composed of multiple cellular layers. The retina is the innermost layer of tissue of the posterior portion of the eye.

Tractional retinal detachment