39 Retinal detachment

Anatomy of retina

Ora serrata Sclera Choroid (supplies outer 2/3 of retina) Retina Ciliary body Vitreous humour /body Optic nerve (composed of ~ 1.3 million axons coming from 1.3 million rods and cones)

Macula Foveola Fovea Retinal vessels (supply inner 1/3 of retina)

Posterior vitreous detachment (PVD) Patient may see 'dirt' or 'a cobweb' or 'a fly'! On ophthalmoscopy:

Floaters More noticeable on a sunny clear day against a blue sky, or white snow, or a white wall/ceiling. They can be particularly annoying when patients find that they get in the way of reading. They are common at any age. NB many people have floaters Posterior vitreous detachment (PVD) The vitreous gel 'jelly' separates from the posterior retina. This also causes 'floaters' such as a Weiss ring and is more common in older patients and myopics WARNING Patients with PVD should be warned of the risk of retinal tear and detachment should they notice a sudden shower of floaters or new flashing lights or a shadow at the edge of their vision, they should seek an urgent ophthalmological opinion

Vitreous body pulls away from retina (to which it is normally attached)

May see Weiss' ring floating in front of disc

Retinal detachment (RD) May get small haemorrhage

On ophthalmoscopy:

Attached flat retina Retinal tear Subretinal fluid Bullous RD overhanging disc and macula Vitreous Macula Pale detached retina Tractional RD

Tobacco dust Retinal hole Detached retina Blood vessel on detached retina Attached flat retina Optic disc

Tractional band from old perforation site

WARNING If the macula is detached there is a risk of permanent visual impairment

84 Sub-specialty Vitreoretinal and medical retina