Treatment

Sudden loss of vision is an ophthalmological emergency and requires immediate referral to the eye emergency department.

Patients experiencing acute onset flashers/floaters without other symptoms (no change in visual acuity, no visual field loss) should be referred urgently to an ophthalmologist (1).

Patients should be educated about the importance of prevention.

• for people with moderate or severe myopia, protective eyewear should be recommended when participating in contact sports.
• it is also important to report symptoms of retinal tears and detachments before undergoing cataract surgery (2).
• limiting physical activity and reduction in eye movement
• bilateral patching (3)

Invariably detachment continues until it it total and the affected eye will become blind. Non - rhegmatogenous detachment may be treated by high dose steroids accompanied by treatment of the underlying cause.

Rhegmatogenous detachment requires that the break be repaired. Flat retinal tears - ie. negligible detachment - may be sealed using laser photocoagulation or cryotherapy.

• it creates an adhesion between the retina and retinal pigment epithelium which will prevent fluid entering the subretinal space (2)
• it is almost 100% effective in preventing propagation of the retinal detachment but new breaks may appear elsewhere (1).

If the retina is detached surgical correction is required to reattach the retina and close any retinal breaks (2). Chorio-retinal apposition may be induced surgically by:

• scleral buckling - indent the sclera to permit apposition of the retina and choroid at the site of the break:
  • cryotherapy to induce an inflammatory reaction
  • plombage - suture pieces of silastic sponge onto the sclera to approximate the tear to the pigmentary epithelium
  • perforate the sclera to drain sub-retinal fluid
• vitrectomy techniques - required when retinal detachment is complicated by severe proliferative vitreoretinopathy:
  • vitrectomy - aspiration of vitreous gel
  • membrane peeling - endoscopic removal of vitreo-retinal membranes off the retinal surface
  • internal tamponade - use of heavy gases or silicone oil to hold the retina flat from internally
• pneumatic retinopexy (1)

Surgical repair of retinal detachment not involving the macula are done on the same day or the following day but if the macula is already detached surgery should be attempted within five days (1).

Reference:

• (1) Kang HK, Luff AJ. Management of retinal detachment: a guide for non-ophthalmologists. BMJ. 2008;336(7655):1235-40
• (2) Gariano RF, Kim CH. Evaluation and management of suspected retinal detachment. Am Fam Physician. 2004;69(7):1691-8
• (3) American Optometric association. Care of patient with retinal detachment and related peripheral vitreoretinal disease