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Symptoms
- analogous to posterior vitreous detachment
- flashes
- mouches volantes / floaters, cobwebs, flies
- blurred vision / haze, reduced visual acuity (with vitreous haemorrhage)
- often asymptomatic with chronic / atrophic tears/holes
Findings
- Tobacco dust? (=pigmented cells in the anterior vitreous), vitreous haemorrhage?
- Fundus examination (with a three-mirror contact lens): Retinal tear/hole? Surrounding retina with subretinal fluid? Operculum?
- In case of vitreous haemorrhage without sufficient fundus view: Ultrasound to exclude retinal detachment
Differential Diagnoses
- Vitreous tuft (vitreoretinal traction)
- Lattice degeneration
Treatment
- Retinal laser
- surround lesion with 3 rows of confluent (white) burns, indentation may be needed
- continue laterally to ora serrata if an anterior row is not possible
- consider cryotherapy if laser is not possible
Follow-up
- after 1-3 days to retreat after incomplete laser sessions
- after 7-14 days to check sufficiency (pigmented spots)
- then check after 1, 3, 6, 12 months then every 6-12 months
- Educate patients about symptoms of retinal detachment (flashes, floaters, curtain-like shadow, reduction in visual acuity)
Sources
- EyeWiki Horseshoe or flap tear
- 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)