Other essential aspects of the history include the timing of the onset of the symptoms, if the patient has the same visual loss symptoms in the fellow eye, whether central visual acuity is affected, prior surgery, or previous trauma. The patient often presents with slowly progressive or fixed visual field loss, typically starting in the periphery and then moving centrally. They may also have significant photopsia (flashes of light) in their vision. Patients with a rhegmatogenous retinal detachment may present with a history of a large number of new-onset floaters. In these detachments, subretinal fluid accumulates due to fluid exudation from a large lesion, such as a tumor or inflammatory mediators. Įxudative or serous retinal detachments also do not involve a break in the neurosensory retina. When the force is strong enough, it can separate the neurosensory retina from the underlying RPE. When there are proliferative membranes in the vitreous or on the retinal surface, these membranes can pull on the neurosensory retina. Tractional retinal detachments do not include a break in the neurosensory retina. A detachment of the retina can lead to severe vision loss, and often without surgical intervention, it can be a permanently blinding condition. This detachment can occur over hours to months, depending on the location of the detachment. The fluid continues to enter underneath the retina so that it peels off from the RPE until the entire posterior retina is detached. When a break occurs, this may allow vitreous to enter the space underneath the neurosensory retina, causing a detachment from the RPE. There are three classifications of retinal detachments: rhegmatogenous retinal detachment, tractional retinal detachment, and exudative retinal detachment.Ī rhegmatogenous retinal detachment is when a tear, break, or hole occurs in the retina. Exudative detachments result from fluid accumulation beneath the sensory retina caused by retinal or choroidal diseases. 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.
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