0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1
Rhegmatogenous Retinal Detachment 1297tests
■B scan ultrasound – performed when poor view of retina – shows
elevated retina.
differential diagnosis
■Posterior vitreous detachment – floaters and flashing lights, vitreous
debris. May precede retinal tears or detachments.
➣Differentiate on – clinical exam with scleral depression.
■Central or branch retinal artery occlusion – Portion or all of retina
appears white.
➣Differentiate on – Clinical exam & Fluorescence angiogram.
■Vitreous hemorrhage – decreased vision, vitreous blood, possible
retinal tear.
➣Differentiate on – clinical exam & B scan ultrasound.
■Retinoschisis (a splitting of retinal layers) – thin elevated peripheral
retina.
➣Differentiate on – clinical exam with scleral depression.
■Choroidal detachment – usually after trauma or surgery.
➣Differentiate on – B scan ultra sound.
management
■Referral to Ophthalmologist within 24 hours if possible.
■Patching eyes not necessary.
■Have patient position head back and keep still until evaluated.
■Stop ASA like products and coumadin if safe to do so.
■Keep NPO if surgery likely within 8 hours.
specific therapy
■All therapy for rhegamatogenous retinal detachments involve
surgery designed to oppose the retina to the underlying retinal pig-
mented epithelium and seal around the retinal tear.
■Laser photocoagulation –
➣Internally burns are placed around tear to create a scar to weld
the retina to underlying tissue.
➣For retinal tears with or without small subclinical retinal detach-
ments.
➣Requires clear view through media.
■Cryoretinopexy –
➣Externally freeze burns are placed through the wall of the eye to
scar the retina to the underlying tissue.
➣For retinal tears with or without small subclinical retinal detach-
ments.
➣Better for poor view, but requires local anesthesia.