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Clinical Summary

Patients often complain of monocular, decreased visual function and may describe a shadow or curtain descending over the eye. Other complaints include cloudy or smoky vision, floaters, or momentary flashes of light. Monocular visual field defects may be noted, and central visual acuity is diminished with macular involvement. Fundal examination may reveal a billowing or tentlike elevation of retina compared with adjacent areas. The elevated retina often appears gray. Retinal holes and tears may be seen, but often the holes, tears, and retinal detachment cannot be seen without indirect ophthalmoscopy.

FIGURE 3.22

Retinal Detachment. A fold of detached retina is seen drooping well in front of the posterior pole, giving the appearance of a “three-dimensional” fundus. (Photo contributor: Department of Ophthalmology, Naval Medical Center, Portsmouth, VA.)

Retinal detachments caused by retinal tears or holes can be associated with trauma, previous ocular surgery, nearsightedness, family history of retinal detachment, and Marfan disease. Retinal detachments caused by traction on the retina by an intraocular process can be because of systemic influences in the eye, such as diabetes mellitus or sickle cell trait. Occasionally retinal detachments are caused by tumors or exudative processes that elevate the retina. Symptoms of “light flashes” may occur with vitreous changes in the absence of retinal pathology. Patients may note flashes of light occurring only in a darkened environment because of the mechanical stimulation of the retina from the extraocular muscles, usually in a nearsighted individual.

Management and Disposition

Urgent ophthalmologic evaluation and treatment are warranted.

Pearls

  1. Often patients have had sensation of flashes of light that occur in a certain area of a visual field in one eye, corresponding to the pathologic pulling on the corresponding retina.

  2. Visual loss may be gradual or sudden.

FIGURE 3.23

Retinal Detachment. Undulating, out-of-focus, elevated retina is seen with few vessels in focus. (Photo contributor: Richard E. Wyszynski, MD.)

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