This is the separation of the sensory retina from the underlying pigmented retinal epithelium.

Presentation

History:

• painless loss of vision (central, peripheral or both)
• Recent history of increased numbers of flashes (due to traction on the retina) and floaters (due to hemorrhage and debris in the vitreous).
• presence of a dark shadow or curtain moving over the visual field of the affected eye.

Examination:

• Visual acuity — reduced if the macula is involved.
• Red reflex — abnormal; a mobile detached retina may be visible.
• Visual fields — reduced.
• Pupils — a mild relative afferent pupillary defect (RAPD) may be present depending the size of the retinal detachment.
• Ophthalmoscopy — The detached retina appears corrugated and partially opaque. On funduscopy the detached portion will appear out of focus.Other features that may be seen include: anterior vitreous pigmented cells, vitreous hemorrhage, and posterior vitreous detachment.

Findings:

• ultrasound — The detached retina is visible as a free floating echogenic membrane separated from the globe posteriorly. It moves with eye movement and is attached at the optic disc.
• ophthalmoscopy — The detached retina appears corrugated and partially opaque. On funduscopy the detached portion will appear out of focus.
• 3 Type of Mechanisms

Management

Direct funduscopy in the emergency department cannot rule out retinal detachment — ultrasound is a useful investigation for diagnosing retinal detachment in the ED.