Retinal Detachment

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  • rhegmatogenous
  • tractive
  • exudative/serous


  • Mouches volantes/floaters, photopsias, peripheral visual field defect/shadow, visual loss


  • Subretinal fluid?: Central retina detached (Macula on/off)?
  • Retinal tears?
    • Examine periphery with contact lens (Goldmann Three Mirror)
    • Always examine opposite eye
    • Tobacco Dust (pigment in vitreous body)?
      • If present: retinal tear present in 70%
  • PVR?
  • in case of exudative/serous: “shifting fluid” (shifting fluid depending on patient positioning)

Differential diagnoses

  • Retinoschisis
    • difference to older retinal detachment: no demarcation line, laser burns (retinal blanching), absolute scotoma
  • Choroidal detachment / effusion

Risk factors

  • Lattice degenerations, peripheral retinal holes, high myopia, intraocular surgery, trauma, previous retinal detachment in the opposite eye, family history


  • Emergency surgical treatment, especially if macula not yet affected (macula on)
  • Time of surgery
    • Macula on: within 24h
    • Macula off: within 72h (after loss of visual acuity)
      • if loss of visual acuity longer than 72h: within 1 week
      • if loss of visual acuity not yet 24h: as soon as possible
  • Until surgery
    • No reading and bed rest (lie on the same side as the detached retina)
  • Pars plana vitrectomy (PPV)
    • Combined with retinopexy (laser, cryo), consider retinectomy
    • local anaesthesia or general anaesthesia possible
    • in Switzerland: most frequently used method for rhegmatogenous retinal detachment
    • Gas filling: SF6 (remains 1-2 weeks), C3F8 (remains 6-8 weeks) or silicone oil filling (must be removed with 2nd operation)
  • Scleral Buckle
    • Combined with retinopexy (laser or cryo), consider drainage of subretinal fluid through small sclerotomy
    • Indication: in young patients (still clear + accommodative crystalline lens, adherent vitreous), in dystrophic foramina or single, smaller tears
  • Pneumatic retinopexy: only used in retinal tears in the superior periphery and involving a single break less than one clock hour
  • Gas or oil
    • Rather gas: uncomplicated rhegmatogenous retinal detachment
    • Rather oil: recurrent retinal detachment, PVR, giant tear


  • Proliferative vitreoretinopathy (PVR):
    • Grading:
      • Grade A (minimal): Vitreous haze, tobacco dust, pigment clots mainly on inferior retina
      • Grade B (moderate): Wrinkling of inner retinal surface, rolled edges of retinal breaks, reduced mobility of vitreous, tortuous vessels, retinal stiffness
      • Grade C (severe): fixed folds covering the entire thickness of the retina, often star-shaped (“star folds”), vitreous condensations and strands
        • anterior (A) or posterior (P)
        • Severity: in clock hours of affected retina
  • Recurrent retinal detachment, cataract due to PPV/gas/oil filling, infection/endophthalmitis, IOP increase (especially under silicone oil)


  • EyeWiki Retinal Detachment
  • EyeWiki Proliferative Vitreoretinopathy
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)