Michelle A.

Macawile
3A2
Introduction...
 It is a disorder of the eye in which
the retina peels away from its
underlying layer of support tissue.
Initial detachment may be
localized, but without rapid
treatment the entire retina may
detach, leading to vision loss and
blindness.
Types of Retinal Detachment:
 Rhegmatogenous retinal detachment – occurs due
to a hole, tear, or break in the retina that allows fluid
to pass from the vitreous space into the subretinal
space between the sensory retina and the retinal
pigment epithelium.
 Exudative, serous, or secondary retinal
detachment – occurs due to inflammation, injury or
vascular abnormalities that results in fluid
accumulating underneath the retina without the
presence of a hole, tear, or break.
 Tractional retinal detachment –occurs when
fibrovascular tissue, caused by an injury,
inflammation or neovascularization, pulls the
sensory retina from the retinal pigment epithelium.
Types of retinal detachment:

Rhegmatogenous
 Most common type,
a tear in the retina
allows fluid to get
under the retina and
separates it from
the retinal pigment
epithelium
Types of retinal detachment:
Tractional
 Scar tissue on
the retina’s
surface
contracts and
causes the retina
to separate from
the retinal
pigment
epithelium
Types of retinal detachment:
Serous/Exudative
 Fluid leaks into
the area
underneath the
retina, but there
are no tear or
breaks in the
retina
Risk Factors:

COMMON: LESS COMMON:

 Aging  Congenital eye
 Cataract Surgery diseases
 Myopia  Diabetic retinopathy
 Trauma  Family history of
 Affects men more than retinal detachment
women
Signs and Symptoms

 Light Flashes (photopsia)

 Wavy or watery vision (metamorphopsia)
 Veil or curtain obstructing vision
 Shower of floaters
 Sudden decrease of vision
Pathophysiology
Diagnostic Exams...
Opthalmoscopy- uses bright light and powerful
lens that allow the doctor to view the inside of the
eye in detail and in 3D. To be able to see a retinal
hole, tear or detachment. (the retina is gray)

Ultrasonography- sends sounds waves through

the eyes to bounce off the retina. The returning
sound waves create an image of the retina and
other eye structures.

Eye chart- test the visual acuity

Direct Funduscopy-
detect hemorrhage and
detachment of the posterior
pole

Slit lamp biomicroscopy-

facilitates an examination of
the anterior segment, or
frontal structures and
posterior segment of the
human eye.
Medications...

Surgery is the only

effective therapy for a
retinal tear or
detachment.
 Surgical management...
 Cryotherapy and Laser photocoagulation –
used alone to wall off a small area of retinal
detachment so that the detachment does not
spread.
 Scleral buckling –sewing one or more
silicone bands to the sclera. It compresses the
sclera to indent the scleral wall from the
outside of the eye and bring the two retinal
layers in contact with each other.
 Pneumatic Retinopexy- a gas bubble (SF
6or C3F8 gas) is injected into the eye after
which laser or freezing treatment is applied to
the retinal hole.
 Vitrectomy- involves the removal of the
vitreous gel and is usually combined with
filling the eye with either a gas bubble or
silicone e oil. There is no myopic shift.
 Electrodiathermy- tiny hole in the
sclera is made to drain subretinal fluid
allowing the RPE to adhere to the retina
Nursing management...
1.Pre-op
 Instruct the patient to remain quiet in prescribed
(dependent) position, to keep the detached area
of the retina in dependent position.
 Patch both eyes.
 Wash the patient’s face with antibacterial
solution.
 Instruct the patient not to touch the eyes to
avoid contamination.
 Administer preoperative medications as ordered.
2.Preventing post-op complications..
 Caution the patient to avoid bumping head.
 Encourage the patient no to cough or sneeze or
to perform other strain-inducing activities that
will increase intraocular pressure.
3. Encourage ambulation and independence
as tolerated.
4. Administer medication for pain, nausea,
and vomiting as directed.
5. Provide quiet diversional activities, such as
listening to a radio or audio books.
6. Teach proper technique in giving eye
medications.
 7. Advise patient to avoid rapid eye
movements for several weeks as well as
straining or bending the head below the
waist.
 8. Advise patient that driving is restricted
until cleared by ophthalmologist.
 9. Teach the patient to recognize and
immediately  report symptoms that indicate
recurring detachment, such as floating spots,
flashing lights, and progressive shadows.
 10. Avoid activities that increase IOP
 11. Avoid straining and bending below the
waist
Thank You!